Balancing science and public policy in Pakistan\u27s COVID-19 response

Background: Coronavirus disease 2019 (COVID-19) has affected the world in an unprecedented manner and South Asian countries were among the first to experience imported cases. Pakistan\u27s response to COVID-19 has been under scrutiny for its granularity, reach and impact.Aims: to evaluate objectively the chronology and depth of the response to COVID-19 in Pakistan.Methods: We evaluated available national and subnational epidemiological and burden information on COVID-19 cases and deaths in Pakistan, including projection models available to the Government at an early stage of the pandemic.Results: Pakistan, with a population of 215 million and considerable geographic diversity, experienced case introduction from pilgrims returning from the Islamic Republic of Iran, followed by widespread community transmission. The National Command and Operations Centre, established through civilian and military partnership, was critical in fast tracking logistics, information gathering, real-time reporting and smart lockdowns, coupled with a massive cash support programme targeting the poorest sections of society. Cases peaked in June 2020 but the health system was able to cope with the excess workload. Since then, although testing rates remain low (\u3e 300 000 cases confirmed to date), case fatality rates have stabilized, and with 6300 deaths, Pakistan seems to have flattened the COVID-19 curve.Conclusion: Despite notable successes in controlling the pandemic, several weaknesses remain and there are risks of rebound as the economy and educational systems reopen. There is continued need for strong technical and programmatic oversight, linked to civic society engagement and working with religious scholars to ensure nonpharmacological intervention compliance

Balancing science and public policy in Pakistan\u27s COVID-19 response

Background: Coronavirus disease 2019 (COVID-19) has affected the world in an unprecedented manner and South Asian countries were among the first to experience imported cases. Pakistan\u27s response to COVID-19 has been under scrutiny for its granularity, reach and impact.Aims: to evaluate objectively the chronology and depth of the response to COVID-19 in Pakistan.Methods: We evaluated available national and subnational epidemiological and burden information on COVID-19 cases and deaths in Pakistan, including projection models available to the Government at an early stage of the pandemic.Results: Pakistan, with a population of 215 million and considerable geographic diversity, experienced case introduction from pilgrims returning from the Islamic Republic of Iran, followed by widespread community transmission. The National Command and Operations Centre, established through civilian and military partnership, was critical in fast tracking logistics, information gathering, real-time reporting and smart lockdowns, coupled with a massive cash support programme targeting the poorest sections of society. Cases peaked in June 2020 but the health system was able to cope with the excess workload. Since then, although testing rates remain low (\u3e 300 000 cases confirmed to date), case fatality rates have stabilized, and with 6300 deaths, Pakistan seems to have flattened the COVID-19 curve.Conclusion: Despite notable successes in controlling the pandemic, several weaknesses remain and there are risks of rebound as the economy and educational systems reopen. There is continued need for strong technical and programmatic oversight, linked to civic society engagement and working with religious scholars to ensure nonpharmacological intervention compliance

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

Bile duct injury during laparoscopic cholecystectomy

Background and Aim: Bile duct injuries (BDIs) are complex complications developed during laparoscopic cholecystectomy leading to the postoperative morbidity and mortality. Auxiliary bile duct injury, vascular structures injuries, portal vein, cyst duct leakage and damage to right hepatic artery are caused by bile duct injuries. The purpose of the present study was to investigate the incidence, clinical presentation, and treatment modality of bile duct injuries during laparoscopic cholecystectomy. Patients and Methods: This descriptive case series was conducted on 96 extra hepatic biliary injuries in the Department of General Surgery, Rehman Medical Institute, Peshawar from April 2022 to March 2023. Patients with extra hepatic biliary injuries of either gender were enrolled. Abdominal ultrasonography, ERCP, and MRCP were the different investigating modalities performed on each individual. Complete blood picture, activated Partial thromboplastin time (APTT), liver function tests, blood sugar, prothrombin time (PT), Creatinine, serum electrolytes, and Urea were thoroughly performed on each patient. HIV, HBs, and HCV were various  screening tests performed. SPSS version 27 was used for data analysis. Results: Of the total 96 patients, there were 26 (27.1%) male and 70 (72.9%) females.&nbsp

Experimental optimization of various heat sinks using passive thermal management system

Organic phase change materials are extensively researched for passive cooling of electronic components due to the high heat of fusion, however, owing to the issue of thermal conductivity, it is difficult to improve the thermal performance of electronic components. However, the effective thermal performance of modern electronic devices is becoming popular due to thermal constraints of the circuit's non-uniform temperature distribution and high heating power generation. Thus, nanomaterials incorporated into phase change materials (PCMs) to improve thermal conductivity, which aids in heat removal and sustains significant heat sink operational performance for extended periods of time. In current research work, at heating powers of (10–30 W), the thermal performance outcome of three heat sink -configurations such as unfinned heat sink, circular pin-finned heat sink and metallic foam integrated heat sink were investigated with several alumina nanomaterials mass concentrations (0.15, 0.20 and 0.25 wt%) incorporated in phase change materials (for example RT-70HC). All three heat sinks revealed lower base temperature with the addition of alumina NePCM (αRT-70HC) phase change materials in their internal cavity compared to the empty unfinned heat sink. The findings showed good performance of metallic foam integrated heat sink in lowering the temperature & increasing safe functional time at two distinct temperatures. The largest decrease in temperature was found to be 35.76% and the largest growth in maximum functional time was 400% for metallic foam integrated heat sink. Therefore, using alumina nanomaterials in phase change material is recommended to optimize the thermal performance of the passive cooling techniques

American Gastroenterological Association-American College of Gastroenterology Clinical Practice Guideline: Pharmacological Management of Chronic Idiopathic Constipation.

INTRODUCTION: Chronic idiopathic constipation (CIC) is a common disorder associated with significant impairment in quality of life. This clinical practice guideline, jointly developed by the American Gastroenterological Association and the American College of Gastroenterology, aims to inform clinicians and patients by providing evidence-based practice recommendations for the pharmacological treatment of CIC in adults. METHODS: The American Gastroenterological Association and the American College of Gastroenterology formed a multidisciplinary guideline panel that conducted systematic reviews of the following agents: fiber, osmotic laxatives (polyethylene glycol, magnesium oxide, lactulose), stimulant laxatives (bisacodyl, sodium picosulfate, senna), secretagogues (lubiprostone, linaclotide, plecanatide), and serotonin type 4 agonist (prucalopride). The panel prioritized clinical questions and outcomes and used the Grading of Recommendations Assessment, Development, and Evaluation framework to assess the certainty of evidence for each intervention. The Evidence to Decision framework was used to develop clinical recommendations based on the balance between the desirable and undesirable effects, patient values, costs, and health equity considerations. RESULTS: The panel agreed on 10 recommendations for the pharmacological management of CIC in adults. Based on available evidence, the panel made strong recommendations for the use of polyethylene glycol, sodium picosulfate, linaclotide, plecanatide, and prucalopride for CIC in adults. Conditional recommendations were made for the use of fiber, lactulose, senna, magnesium oxide, and lubiprostone. DISCUSSION: This document provides a comprehensive outline of the various over-the-counter and prescription pharmacological agents available for the treatment of CIC. The guidelines are meant to provide a framework for approaching the management of CIC; clinical providers should engage in shared decision making based on patient preferences as well as medication cost and availability. Limitations and gaps in the evidence are highlighted to help guide future research opportunities and enhance the care of patients with chronic constipation

American Gastroenterological Association-American College of Gastroenterology Clinical Practice Guideline: Pharmacological Management of Chronic Idiopathic Constipation.

INTRODUCTION: Chronic idiopathic constipation (CIC) is a common disorder associated with significant impairment in quality of life. This clinical practice guideline, jointly developed by the American Gastroenterological Association and the American College of Gastroenterology, aims to inform clinicians and patients by providing evidence-based practice recommendations for the pharmacological treatment of CIC in adults. METHODS: The American Gastroenterological Association and the American College of Gastroenterology formed a multidisciplinary guideline panel that conducted systematic reviews of the following agents: fiber, osmotic laxatives (polyethylene glycol, magnesium oxide, lactulose), stimulant laxatives (bisacodyl, sodium picosulfate, senna), secretagogues (lubiprostone, linaclotide, plecanatide), and serotonin type 4 agonist (prucalopride). The panel prioritized clinical questions and outcomes and used the Grading of Recommendations Assessment, Development, and Evaluation framework to assess the certainty of evidence for each intervention. The Evidence to Decision framework was used to develop clinical recommendations based on the balance between the desirable and undesirable effects, patient values, costs, and health equity considerations. RESULTS: The panel agreed on 10 recommendations for the pharmacological management of CIC in adults. Based on available evidence, the panel made strong recommendations for the use of polyethylene glycol, sodium picosulfate, linaclotide, plecanatide, and prucalopride for CIC in adults. Conditional recommendations were made for the use of fiber, lactulose, senna, magnesium oxide, and lubiprostone. DISCUSSION: This document provides a comprehensive outline of the various over-the-counter and prescription pharmacological agents available for the treatment of CIC. The guidelines are meant to provide a framework for approaching the management of CIC; clinical providers should engage in shared decision making based on patient preferences as well as medication cost and availability. Limitations and gaps in the evidence are highlighted to help guide future research opportunities and enhance the care of patients with chronic constipation

Arctium lappa (Burdock): Insights from ethnopharmacology potential, chemical constituents, clinical studies, pharmacological utility and nanomedicine

Arctium lappa L. is a medicinal edible homologous plant, commonly known as burdock or bardana, which belongs to the Asteraceae family. It is widely distributed throughout Northern Asia, Europe, and North America and has been utilized for hundreds of years. The roots, fruits, seeds, and leaves of A. lappa have been extensively used in traditional Chinese Medicine (TCM). A. lappa has attracted a great deal of attention due to its possession of highly recognized bioactive metabolites with significant therapeutic potential. Numerous pharmacological effects have been demonstrated in vitro and in vivo by A. lappa and its bioactive metabolites, including antimicrobial, anti-obesity, antioxidant, anticancer, anti-inflammatory, anti-diabetic, anti-allergic, antiviral, gastroprotective, hepatoprotective, and neuroprotective activities. Additionally, A. lappa has demonstrated considerable clinical efficacies and valuable applications in nanomedicine. Collectively, this review covers the properties of A. lappa and its bioactive metabolites, ethnopharmacology aspects, pharmacological effects, clinical trials, and applications in the field of nanomedicine. Hence, a significant attention should be paid to clinical trials and industrial applications of this plant with particular emphasis, on drug discovery and nanotechnology

Arctium lappa (Burdock) : Insights from ethnopharmacology potential, chemical constituents, clinical studies, pharmacological utility and nanomedicine

Arctium lappa L. is a medicinal edible homologous plant, commonly known as burdock or bardana, which belongs to the Asteraceae family. It is widely distributed throughout Northern Asia, Europe, and North America and has been utilized for hundreds of years. The roots, fruits, seeds, and leaves of A. lappa have been extensively used in traditional Chinese Medicine (TCM). A. lappa has attracted a great deal of attention due to its possession of highly recognized bioactive metabolites with significant therapeutic potential. Numerous pharmacological effects have been demonstrated in vitro and in vivo by A. lappa and its bioactive metabolites, including antimicrobial, antiobesity, antioxidant, anticancer, anti-inflammatory, anti-diabetic, anti-allergic, antiviral, gastroprotective, hepatoprotective, and neuroprotective activities. Additionally, A. lappa has demonstrated considerable clinical efficacies and valuable applications in nanomedicine. Collectively, this review covers the properties of A. lappa and its bioactive metabolites, ethnopharmacology aspects, pharmacological effects, clinical trials, and applications in the field of nanomedicine. Hence, a significant attention should be paid to clinical trials and industrial applications of this plant with particular emphasis, on drug discovery and nanotechnology

Saudi Arabian Plants: A Powerful Weapon against a Plethora of Diseases

The kingdom of Saudi Arabia (SA) ranks fifth in Asia in terms of area. It features broad biodiversity, including interesting flora, and was the historical origin of Islam. It is endowed with a large variety of plants, including many herbs, shrubs, and trees. Many of these plants have a long history of use in traditional medicine. The aim of this review is to evaluate the present knowledge on the plants growing in SA regarding their pharmacological and biological activities and the identification of their bioactive compounds to determine which plants could be of interest for further studies. A systematic summary of the plants’ history, distribution, various pharmacological activities, bioactive compounds, and clinical trials are presented in this paper to facilitate future exploration of their therapeutic potential. The literature was obtained from several scientific search engines, including Sci-Finder, PubMed, Web of Science, Google Scholar, Scopus, MDPI, Wiley publications, and Springer Link. Plant names and their synonyms were validated by ‘The Plant List’ on 1 October 2021. SA is home to approximately 2247 plant species, including native and introduced plants that belong to 142 families and 837 genera. It shares the flora of three continents, with many unique features due to its extreme climate and geographical and geological conditions. As plants remain the leading supplier of new therapeutic agents to treat various ailments, Saudi Arabian plants may play a significant role in the fight against cancer, inflammation, and antibiotic-resistant bacteria. To date, 102 active compounds have been identified in plants from different sites in SA. Plants from the western and southwestern regions have been evaluated for various biological activities, including antioxidant, anti-cancer, antimicrobial, antimalarial, anti-inflammatory, anti-glycation, and cytotoxic activities. The aerial parts of the plants, especially the leaves, have yielded most of the bioactive compounds. Most bioactivity tests involve in vitro assessments for the inhibition of the growth of tumour cell lines, and several compounds with in vitro antitumour activity have been reported. More in-depth studies to evaluate the mode of action of the compounds are necessary to pave the way for clinical trials. Ecological and taxonomical studies are needed to evaluate the flora of SA, and a plan for the conservation of wild plants should be implemented, including the management of the protection of endemic plants