The Growth of E-Marketing in Business-to-Business Industry and its effect on the Performance of Businesses in Pakistan: Marketing Success

E-marketing has emerged as one of the significant drivers in sustaining the firms competitive advantage. So far, there is a lack of systematic empirical evidence regarding the marketing activities which are drastically affected by the use of e-marketing in small and large firms of Pakistan and their consequent performance outcomes. However, the objective of this study is to examine the technological, organizational and environmental factors on the performance of small and large firms in Pakistan with mediating role of E-Marketing uses and its generlizibality on countries with similar economic situation. Cross sectional data were collected from 257 manufacturing companies in Pakistan; general manager marketing were selected as the data collection sources. Additionally, SmartPLS 3.0, two step path-modeling has been used to examine the direct as well as indirect hypothesis of the current study. However, the results generated from SmartPLS (SEM) path-modeling found that, with regard to direct relationships, three variables (technology orientation, top management support, use of e-marketing) out of five including mediation variable have found significant positively associated with firm performance, however, only one (competitive pressure) has found negatively significant with firm performance. Finally, in terms of use of e-marketing as mediating variable between the relationships of technological, organizational, environmental factors and firm performance, three out of four (independent variables) indicate partial mediation including technological factors (technology orientation), organizational factors (top management support) and environmental factors (competitive pressure). However, market orientation had shown insignificant results both in the direct relationship as well as by including E-Marketing uses.

The growth of e-marketing in business-to-business industry and its effect on the performance of businesses in Pakistan: marketing success

E-marketing has emerged as one of the significant drivers in sustaining the firms competitive advantage. So far, there is a lack of systematic empirical evidence regarding the marketing activities which are drastically affected by the use of e-marketing in small and large firms of Pakistan and their consequent performance outcomes. However, the objective of this study is to examine the technological, organizational and environmental factors on the performance of small and large firms in Pakistan with mediating role of E-Marketing uses and its generlizibality on countries with similar economic situation. Cross sectional data were collected from 257 manufacturing companies in Pakistan; general manager marketing were selected as the data collection sources. Additionally, SmartPLS 3.0, two step path-modeling has been used to examine the direct as well as indirect hypothesis of the current study. However, the results generated from SmartPLS (SEM) path-modeling found that, with regard to direct relationships, three variables (technology orientation, top management support, use of e-marketing) out of five including mediation variable have found significant positively associated with firm performance, however, only one (competitive pressure) has found negatively significant with firm performance. Finally, in terms of use of e-marketing as mediating variable between the relationships of technological, organizational, environmental factors and firm performance, three out of four (independent variables) indicate partial mediation including technological factors (technology orientation), organizational factors (top management support) and environmental factors (competitive pressure). However, market orientation had shown insignificant results both in the direct relationship as well as by including E-Marketing uses

The epidemiology of stroke In a developing country (Pakistan)

Ischemic stroke is a major cause of neurological morbidity and mortality. The objective of this review article is to summarize facts pertaining to acute ischemic stroke and its various aspects in a developing country like Pakistan, where resources are limited and the healthcare system is underdeveloped. No large-scale epidemiological studies are available to determine the true incidence of stroke in Pakistan. We conducted a study to determine the prevalence of several important stroke risk factors among Pakistani stroke patients, and to determine whether these risk factors differ among urban versus rural populations. We also used existing data from literature to compare overall stroke incidence in Pakistan to that in developed countries. In this study we found that for stroke besides hypertension, prolonged contraceptive use and pregnancy are additional risk factors in Pakistan. Which is more prevalent in urban populations than rural population? Developed countries except Germany have much lower stroke incidences than Pakistan

Current status of Helicobacter pylori association with haematological and cardiovascular diseases: A mini review

Helicobacter pylori infection is considered the most commonly prevalent gastrointestinal pathogen where it manages to survive despite the hostile environment of human stomach, leading to various gastric diseases including gastric cancer. Due to the chronic inflammatory state induced by H. pylori and its interaction with host immune system have diverted researchers to investigate its correlation with systemic diseases outside of the gastrointestinal tract. This literature review was done to explore the association of H. pylori infection with haematological and cardiovascular diseases. We used medical subject heading (MeSH) terms Helicobacter pylori with inflammation, haematological diseases, coronary heart diseases or vascular diseases to search PubMed database. All relevant studies identified from 2005 to 2015 were included. As many of the studies are small-scale or showed weak association, further studies are needed to address the role of H. pylori in pathogenesis of haematological and cardiovascular diseases

Presentation of Acute Lymphoblastic Lymphoma and Colorectal Carcinoma in the Context of Constitutional Mismatch Repair Deficiency Syndrome (CMMRD): a Case Report with Literature Review

Introduction: Constitutional mismatch repair deficiency (CMMRD) is a rare autosomal recessive disease-carrying an increased risk of cancers (pediatric tumors of central nervous system, haemato-lymphoid malignancies along with gastrointestinal (GI) cancer(s), which are usually seen in the second and third decade) leading to syndromic presentation. Causal mutations are detected in DNA mismatch repair (MMR) genes, including MLH1, PMS2, MSH2, and MSH6 that are also known for their established role in Lynch syndrome. We describe a case of CMMRD with an earlier (first decade of life) presentation of mediastinal acute lymphoblastic lymphoma and colorectal malignancy. Case Presentation: A five-year-old boy presented with respiratory complaints, bilateral cervical lymphadenopathy, multiple café au lait macules (CALMs) on the lower back, history of parental consanguinity with the death of three sisters due to brain tumor within 6 months of diagnosis. Computerized tomographic (CT) scan chest revealed a huge mediastinal mass. The patient underwent a trucut-biopsy of the mass. The results were significant for a pre T-cell acute lymphoblastic lymphoma. Suspicion of CMMRD was raised based on a combination of factors described above. A panel of mismatch repair (MMR) proteins was applied on the biopsy tissue that revealed loss of nuclear expression of MLH1 and PMS2 immunostaining in tumor cells with positive external controls. While on maintenance therapy for lymphoma, about a year later, the patient developed sub-acute intestinal obstruction due to a stenosing polypoidal circumferential tumor in the mid-sigmoid colon found on flexible sigmoidoscopy that was followed by endoscopic biopsies and insertion of a fully-covered self-expanding metallic adult biliary stent with a diameter of 10 mm and length of 6 cm leading to immediate relief of obstruction. Biopsies revealed adenocarcinoma with neuroendocrine differentiation. Metastatic tumor deposits were seen in the omentum, anterior abdominal wall, and the left peritoneal wall. Practical Implications: Earlier (first decade) presentation of gastrointestinal malignancy warrants that an earlier screening through radiological scans for any possible tumors and MMR protein expression analysis (loss in tumor plus normal non-tumor cells) are essential in patients having CALMs and family history of pediatric tumors

Psychometric validity of the distress thermometer and problem check list in ART-na\uefve HIV infected patients in Northern Nigeria

Background: HIV diagnosis comes with a lot of worry and distress. Ability to objectively estimate this distress by non-psychiatrist will enhance early detection of psychological distress for intervention. Objectives: To investigate the validity of the Distress Thermometer (DT) and its problem checklist in achieving early detection of mental distress among ART-na\uefve HIV infected patient. Materials and Methods: A total of 90 ART-na\uefve HIV infected patients completed the DT and its problem check list, Hospital Anxiety Depression Scale (HADS), Oslo Social Support Scale and the 14-item Resilience Scale. Results: The DT was positively correlated with all the measures of distress and reversely correlated with all the positive wellness in this study. The correlations were only significant for the negative measures of psychological wellness. The internal consistency of the DT\u2019s problem list overall and sub-categories were within acceptable range (i.e. \u3b1 > 0.50). The Receiver Operating Characteristic (ROC) curves and Area Under the Curves (AUC) analysis were significant and found the DT and Problem List to respectively differentiate between cases of distress, anxiety and depression. The DT\u2019s cut-off was >5.0 with AUC range (0.754 \u2013 0.709); sensitivity range (81.0% \u2013 70.4%); specificity range (68.3% \u2013 65.2%) for distress, anxiety and depression as determined by HADS. And the Problem List cut-off was >6.0 with AUC range (0.854 \u2013 0.821); sensitivity range (90.5% - 85.7%); specificity range (68.3% - 65.2%) for distress, anxiety and depression as measured by HADS. Conclusion: The DT and Problem List were found to be valid measures of distress in ART-na\uefve HIV infected patients

Underutilized Grasses Production: New Evolving Perspectives

Globally, over-reliance on major food crops (wheat, rice and maize) has led to food basket’s shrinking, while climate change, environmental pollution and deteriorating soil fertility demand the cultivation of less exhaustive but nutritious grasses. Unlike neglected grasses (grass species restricted to their centres of origin and only grown at the subsistence level), many underutilized grasses (grass species whose yield or usability potential remains unrealized) are resistant and resilient to abiotic stresses and have multiple uses including food (Coix lacryma-jobi), feed (Eragrostis amabilis and Cynodon dactylon), esthetic value (Miscanthus sinensis and Imperata cylindrica), renewable energy production (Spartina pectinata and Andropogon gerardii Vitman) and contribution to ecosystem services (Saccharum spontaneum). Lack of agricultural market globalization, urbanization and prevalence of large commercial enterprises that favor major grasses trade, improved communication means that promoted specialization in favor of established crops, scant planting material of underutilized grasses and fewer research on their production technology and products development are the prime challenges posed to underutilized grasses promotion. Integration of agronomic research with novel plant protection measures and plant breeding and molecular genetics approaches for developing biotic and abiotic stresses tolerant cultivars along with the development of commercially attractive food products hold the future key for promoting underutilized grasses for supplanting food security and sustainably multiplying economic outcomes

Routine immunization coverage in Pakistan: a survey of children under 1 year of age in community-based vaccination areas.

Pakistan is one of two countries in which poliovirus remains endemic. Considering the high number of children born every year, reaching and vaccinating new birth cohorts by improving routine immunization coverage in children <1 year of age is crucial to halting virus transmission. In 2015, a community-based vaccination (CBV) strategy, using local community members to enhance vaccine acceptance and improve routine immunization service delivery, was introduced in areas of Pakistan that have never interrupted poliovirus transmission. In order to assess progress towards improving routine immunization, we performed house-to-house immunization surveys across ten CBV areas in 2017 and 2018. In each household, we determined age-appropriate routine antigen coverage for children <1 year of age based on vaccination card and caregiver recall. We surveyed 5,499 and 5,264 children in 2017 and 2018, respectively. Overall, coverage of inactivated poliovirus vaccine (IPV) at 14 weeks of age was 32% in 2017 and 39% in 2018 based on vaccination card and recall. Across the surveyed areas, coverage ranged from 7% in Killa Abdullah to 61% in Peshawar in 2018. Oral poliovirus vaccination coverage decreased with successive vaccination visits, ranging from 66% for the birth dose to 42% for the 14-week dose in 2018. No area reached the target of 80% coverage for any routine antigen. Our findings highlight the need for concerted efforts to improve routine immunization coverage in these critical areas of wild poliovirus transmission

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