ENERGY SECURITY AND ECONOMIC GROWTH IN PAKISTAN

Energy is a crucial input in the process of economic growth. Sustainable economic growth necessitates the sufficient and continuous availability of energy. Pakistan is confronting energy insecurity which is seriously hindering the economic development and this study is an attempt to investigate the relationship between energy security and economic growth. The major concern of energy security is associated with the availability of suitable energy supply in cheap and consistent way to fulfill energy demand in the future. In this study, the demand and supply gap of energy is used as a proxy variable for energy security. The data source is the Energy Information Administration (EIA) where data is available at disaggregate level for different sources of energy (i.e., oil, gas, coal and electricity) for the period of 1980 to 2012. Therefore, aggregate variables are generated by converting data into unified unit of measurement. The Error Correction Model (ECM) is used to analyze the short-run and long-run causality between energy gap and the economic growth. The results show that unidirectional causality runs from energy demand and supply gap to economic growth in short-run as well as in the long-run. This relationship is negative and statistically significant in both the short- run and the long run which indicates that low energy security (i.e., increasing energy gap) halts the economic growth of Pakistan. Consequently, the study concludes that government should focus on better management of energy demand and energy supply

Filtered mud improves sugarcane growth and modifies the functional abundance and structure of soil microbial populations

Background Exploring high-quality organic amendments has been a focus of sustainable agriculture. Filtered mud (FM), a sugar factory waste derived from sugarcane stems, could be an alternative organic amendment for sugarcane production. However, the effects of its application proportions on soil fertility, nutrient cycling, structure of soil bacterial and fungal communities, and the growth of sugarcane in clay-loam soils remain unexplored. Methods Three application proportions of FM: (FM1-(FM: Soil at 1:4), FM2-(FM: Soil at 2:3), and FM3-(FM: Soil at 3:2)) were evaluated on sugarcane growth and soil nutrient cycling. High throughput sequencing was also employed to explore soil microbial dynamics. Results We observed that FM generally increased the soil’s nutritional properties while improving NO3− retention compared to the control, resulting in increased growth parameters of sugarcane. Specifically, FM1 increased the concentration of NH4+−N, the N fraction preferably taken up by sugarcane, which was associated with an increase in the plant height, and more improved growth properties, among other treatments. An increase in the proportion of FM also increased the activity of soil nutrient cycling enzymes; urease, phosphatase, and β-glucosidase. High throughput sequencing revealed that FM reduced the diversity of soil bacteria while having insignificant effects on fungal diversity. Although increasing FM rates reduced the relative abundance of the phyla Proteobacteria, its class members, the Gammaproteobacteria and Betaproteobacteria containing some N-cycling related genera, were stimulated. Also, FM stimulated the abundance of beneficial and lignocellulose degrading organisms. These included the bacterial phyla Actinobacteria, Bacteroidetes, Acidobacteria, Chloroflexi, and the fungal phylum Ascomycota. The distribution of the soil microbial community under FM rates was regulated by the changes in soil pH and the availability of soil nutrients. Since FM1 showed more promise in improving the growth properties of sugarcane, it could be more economical and sustainable for sugarcane production in clay-loam soils

Clinical practice guidelines on the management of variceal bleeding

Gastroesophageal variceal bleeding occurs in 30 - 50% of patients of liver cirrhosis with portal hypertension, with 20-70% mortality in one year. Therefore, it is essential to screen these patients for varices and prevent first episode of bleeding by treating them with β-blockers or endoscopic variceal band ligation. Ideally, the patients with variceal bleeding should be treated in a unit where the personnel are familiar with the management of such patients and where routine therapeutic interventions can be undertaken. Proper management of such patients include: initial assessment, resuscitation, blood volume replacement, vasoactive agents, prevention of associated complications such as bacterial infections, hepatic encephalopathy, coagulopathy and thrombocytopenia, and specific therapy. Rebleeding occurs in about 60% patients within 2 years of their recovery from first variceal bleeding episode, with 33% mortality. Therefore, it is mandatory that all such patients must be started on combination of β-blockers and band ligation to prevent recurrence of bleeding. Patients who required shunt surgery/TIPSS to control the acute episode do not require further preventive measures. These clinical practice guidelines (CPGs) have been jointly developed by Pakistan Society of Hepatology (PSH) and Pakistan Society of Study of Liver Diseases (PSSLD)

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

Isolation and Identification of Polioviruses from Stool Specimens of Suspected Cases

Background: To study the isolation and identification of polioviruses from the stool specimen of suspected cases of poliomyelitis (polio). Methods : In this descriptive study two poliovirus-sensitive cell lines of human origin HEp-2, and RD were used for poliovirus isolation. Two hundred and two samples of stool specimen were processed according to the WHO recommendations. Supernatant of stool specimen were inoculated on HEp-2, and RD for poliovirus culture, and incubated at 36oC. Cultures were initially set up in growth medium supplemented with serum. After the formation of a confluent monolayer from the cells, cultures were changed to maintenance medium, designed to maintain cultures in healthy state without stimulating growth. The tubes were incubated , and put in racks at inclined angle of 5o , with line (blue for HEp-2, and black for RD cell line) of tube in upper position. Cultures were daily examined for color change from pinkish to yellow, and for appearance of cytopathic effects (CPEs) under the inverted microscope for 10-14 days before discarding as negative. The yellowish coloration indicated the absence of poliovirus while no color change was indicative of presence of poliovirus, and presence of characteristic CPEs production of poliovirus i.e. rounding of cells, and detachment of cells from culture tubes. Tubes showing CPEs were stored at -20oC. Identification of poliovirus isolates was done by mixing the diluted isolates samples, with equal volumes of a set of antisera of known poliovirus serotypes. The antiserum/ poliovirus mixture was incubated for 2 hr to allow binding of antibodies to poliovirus. Afterwards the mixtures were inoculated into cell culture tubes, and examined daily for CPEs. Prevention of the development of CPEs by the specific antiserum, indicated the identity of the poliovirus serotype. The identification of both isolates from RD as well as Hep-2 cell cultures, was carried on as poliovirus susceptibility of these two lines varies.Results: Majority of cases(38.1%) were of 3-12 months, followed by 13-24 months (34.6%). Male to female ratio was 1.4:1.0. Among the suspected cases, 94% were vaccinated, while about 2% were partially vaccinated. Poliovirus was isolated from 28.2% stool specimens of suspected cases of polio. The poliovirus type 1 was found 75.4%, one of the most common among positive cases. 35% cases were found from Punjab and 28% from KPKConclusion: Most prevalent type of poliovirus is type-1, and the maximum number of polio is found in the province Punjab. The most vulnerable age group for polio was 3-12 months, and the target age less than 5 years, that covered the percentage of total number of cases upto 99%. Moreover, 94.06% cases of polio were unvaccinated

Isolation and Identification of Polioviruses from Stool Specimens of Suspected Cases

Background: To study the isolation and identification of polioviruses from the stool specimen of suspected cases of poliomyelitis (polio). Methods : In this descriptive study two poliovirus-sensitive cell lines of human origin HEp-2, and RD were used for poliovirus isolation. Two hundred and two samples of stool specimen were processed according to the WHO recommendations. Supernatant of stool specimen were inoculated on HEp-2, and RD for poliovirus culture, and incubated at 36oC. Cultures were initially set up in growth medium supplemented with serum. After the formation of a confluent monolayer from the cells, cultures were changed to maintenance medium, designed to maintain cultures in healthy state without stimulating growth. The tubes were incubated , and put in racks at inclined angle of 5o , with line (blue for HEp-2, and black for RD cell line) of tube in upper position. Cultures were daily examined for color change from pinkish to yellow, and for appearance of cytopathic effects (CPEs) under the inverted microscope for 10-14 days before discarding as negative. The yellowish coloration indicated the absence of poliovirus while no color change was indicative of presence of poliovirus, and presence of characteristic CPEs production of poliovirus i.e. rounding of cells, and detachment of cells from culture tubes. Tubes showing CPEs were stored at -20oC. Identification of poliovirus isolates was done by mixing the diluted isolates samples, with equal volumes of a set of antisera of known poliovirus serotypes. The antiserum/ poliovirus mixture was incubated for 2 hr to allow binding of antibodies to poliovirus. Afterwards the mixtures were inoculated into cell culture tubes, and examined daily for CPEs. Prevention of the development of CPEs by the specific antiserum, indicated the identity of the poliovirus serotype. The identification of both isolates from RD as well as Hep-2 cell cultures, was carried on as poliovirus susceptibility of these two lines varies.Results: Majority of cases(38.1%) were of 3-12 months, followed by 13-24 months (34.6%). Male to female ratio was 1.4:1.0. Among the suspected cases, 94% were vaccinated, while about 2% were partially vaccinated. Poliovirus was isolated from 28.2% stool specimens of suspected cases of polio. The poliovirus type 1 was found 75.4%, one of the most common among positive cases. 35% cases were found from Punjab and 28% from KPKConclusion: Most prevalent type of poliovirus is type-1, and the maximum number of polio is found in the province Punjab. The most vulnerable age group for polio was 3-12 months, and the target age less than 5 years, that covered the percentage of total number of cases upto 99%. Moreover, 94.06% cases of polio were unvaccinated

Polymorphism of the renalase gene in gestational diabetes mellitus

Renalase is considered as a novel candidate gene for type 2 diabetes. In this study, we aimed to investigate the relationship of serum renalase and two single nucleotide polymorphisms with gestational diabetes mellitus. One hundred and ninety-eight normotensive pregnant females (n=99 gestational diabetes mellitus; n=99 euglycemic pregnant controls) were classified according to the International Association of the Diabetes and Pregnancy Study criteria. Fasting and 2-h post glucose load blood levels and anthropometric assessment was performed. Serum renalase was measured using enzyme-linked immunosorbent assay, whereas DNA samples were genotyped for renalase single nucleotide polymorphisms rs2576178 and rs10887800 using Polymerase chain reaction-Restriction fragment length polymorphism method. In an age-matched case control study, no difference was observed in the serum levels of renalase (p\u3e0.05). The variant rs10887800 showed an association with gestational diabetes mellitus and remained significant after multiple adjustments (p\u3c0.05), whereas rs2576178 showed weak association (p=0.030) that was lost after multiple adjustments (p=0.09). We inferred a modest association of the rs10887800 polymorphism with gestational diabetes. Although gestational diabetes mellitus is self-reversible, yet presence of this minor G allele might predispose to metabolic syndrome phenotypes in near the future

WHO Global Situational Alert System: a mixed methods multistage approach to identify country-level COVID-19 alerts

Background Globally, since 1 January 2020 and as of 24 January 2023, there have been over 664 million cases of COVID-19 and over 6.7 million deaths reported to WHO. WHO developed an evidence-based alert system, assessing public health risk on a weekly basis in 237 countries, territories and areas from May 2021 to June 2022. This aimed to facilitate the early identification of situations where healthcare capacity may become overstretched.Methods The process involved a three-stage mixed methods approach. In the first stage, future deaths were predicted from the time series of reported cases and deaths to produce an initial alert level. In the second stage, this alert level was adjusted by incorporating a range of contextual indicators and accounting for the quality of information available using a Bayes classifier. In the third stage, countries with an alert level of ‘High’ or above were added to an operational watchlist and assistance was deployed as needed.Results Since June 2021, the system has supported the release of more than US$27 million from WHO emergency funding, over 450 000 rapid antigen diagnostic testing kits and over 6000 oxygen concentrators. Retrospective evaluation indicated that the first two stages were needed to maximise sensitivity, where 44% (IQR 29%–67%) of weekly watchlist alerts would not have been identified using only reported cases and deaths. The alerts were timely and valid in most cases; however, this could only be assessed on a non-representative sample of countries with hospitalisation data available.Conclusions The system provided a standardised approach to monitor the pandemic at the country level by incorporating all available data on epidemiological analytics and contextual assessments. While this system was developed for COVID-19, a similar system could be used for future outbreaks and emergencies, with necessary adjustments to parameters and indicators

Prophylactic biological mesh reinforcement versus standard closure of stoma site (ROCSS): a multicentre, randomised controlled trial

Background: Closure of an abdominal stoma, a common elective operation, is associated with frequent complications; one of the commonest and impactful is incisional hernia formation. We aimed to investigate whether biological mesh (collagen tissue matrix) can safely reduce the incidence of incisional hernias at the stoma closure site. Methods: In this randomised controlled trial (ROCSS) done in 37 hospitals across three European countries (35 UK, one Denmark, one Netherlands), patients aged 18 years or older undergoing elective ileostomy or colostomy closure were randomly assigned using a computer-based algorithm in a 1:1 ratio to either biological mesh reinforcement or closure with sutures alone (control). Training in the novel technique was standardised across hospitals. Patients and outcome assessors were masked to treatment allocation. The primary outcome measure was occurrence of clinically detectable hernia 2 years after randomisation (intention to treat). A sample size of 790 patients was required to identify a 40% reduction (25% to 15%), with 90% power (15% drop-out rate). This study is registered with ClinicalTrials.gov, NCT02238964. Findings: Between Nov 28, 2012, and Nov 11, 2015, of 1286 screened patients, 790 were randomly assigned. 394 (50%) patients were randomly assigned to mesh closure and 396 (50%) to standard closure. In the mesh group, 373 (95%) of 394 patients successfully received mesh and in the control group, three patients received mesh. The clinically detectable hernia rate, the primary outcome, at 2 years was 12% (39 of 323) in the mesh group and 20% (64 of 327) in the control group (adjusted relative risk [RR] 0·62, 95% CI 0·43–0·90; p=0·012). In 455 patients for whom 1 year postoperative CT scans were available, there was a lower radiologically defined hernia rate in mesh versus control groups (20 [9%] of 229 vs 47 [21%] of 226, adjusted RR 0·42, 95% CI 0·26–0·69; p<0·001). There was also a reduction in symptomatic hernia (16%, 52 of 329 vs 19%, 64 of 331; adjusted relative risk 0·83, 0·60–1·16; p=0·29) and surgical reintervention (12%, 42 of 344 vs 16%, 54 of 346: adjusted relative risk 0·78, 0·54–1·13; p=0·19) at 2 years, but this result did not reach statistical significance. No significant differences were seen in wound infection rate, seroma rate, quality of life, pain scores, or serious adverse events. Interpretation: Reinforcement of the abdominal wall with a biological mesh at the time of stoma closure reduced clinically detectable incisional hernia within 24 months of surgery and with an acceptable safety profile. The results of this study support the use of biological mesh in stoma closure site reinforcement to reduce the early formation of incisional hernias. Funding: National Institute for Health Research Research for Patient Benefit and Allergan