Current standards of postgraduate surgical education and training in Pakistan: Time to bridge the gaps in lieu of national necessity

The provision of good-quality surgical care is a salient feature of every public health system. Pakistan is ranked among low and middle-income countries where the burden of surgical disease is rapidly increasing, but the capacity of the health system has not expanded at the same pace to cater current needs. One of the key components is the dearth of trained surgical specialists and lack of easy access to surgical care. College of Physicians and Surgeons, Pakistan is the main certifying institution for surgeons, while public and private teaching hospitals bear the burden of responsibility for surgical education and training. The current review article was planned to describe current standards of postgraduate surgical education and training in Pakistan and to highlight the challenges that need to be faced and the existent deficiencies that need to be met to match the nation\u27s demand against the immense burden of surgical diseases

Impact of a global pandemic on surgical education and training- review, response, and reflection

The catastrophic effects of the coronavirus disease-2019 global pandemic have revolutionised human society. The unprecedented impact on surgical training needs to be analysed in detail to achieve an understanding of how to deal with similar situations arising in the foreseeable future. The challenges faced by the surgical community initiated with the suspension of clinical activities and elective practice, and included the lack of appropriate personal protective equipment, and the self-isolation of trainees and reassignment to coronavirus patient-care regions. Together, all these elements had deleterious effects on the psychological health of the professionals. Surgical training irrespective of specialty is equally affected globally by the pandemic. However, the global crisis inadvertently has led to a few constructive adaptations in healthcare systems, including the development of tele-clinics, virtual academic sessions and conferences, and increased usage of simulation. The current review article was planned to highlight the impact of corona virus disease on surgical training and institutions\u27 response to the situation in order to continue surgical training, and lessons learnt from the pandemic

Acute presentation of cocoon abdomen as septic peritonitis mimicking with strangulated internal herniation: A case report

Background: Abdominal cocoon syndrome is a rare cause of intestinal obstruction in which loops of small bowel get entrapped inside a fibro-collagenous membrane. Condition is also known in the literature as sclerosing peritonitis and in the majority of cases, it has no known cause. Although the majority of patients exhibit long-standing signs and symptoms of partial bowel obstruction in an out-patient clinic, its acute presentation in the emergency room with features of sepsis is extremely rare. This case report aims to describe the emergency presentation of cocoon abdomen with septic peritonitis.Case presentation: A 35-year-old male with no known co-morbidity and no prior history of prior laparotomy presented in emergency room first time with a 1-day history of generalized abdomen pain, vomiting, and absolute constipation. He was in grade III shock and had metabolic acidosis. The clinical impression was of the perforated appendix, but initial contrast-enhanced computed tomography (CECT) was suggestive of strangulated internal herniation of small bowel. Emergency laparotomy after resuscitation revealed hypoperfused, but viable loops of small bowel entrapped in the sclerosing membrane. Extensive adhesiolysis and removal of the membrane were performed and the entire bowel was straightened. Postoperatively he remained well and discharged as planned. Histopathology report confirms features of sclerosing peritonitis.Discussion: Cocoon abdomen is a very rare cause of acute small bowel obstruction presenting in an emergency with features of septic peritonitis. Condition is mostly chronic and generally mimics abdominal TB in endemic areas like India and Pakistan. A high index of suspicion is required in an emergency setting and exploratory laparotomy is diagnostic and therapeutic as well and the condition mimics internal herniation in acute cases.Conclusion: Cocoon abdomen as a cause of septic peritonitis is extremely rare and might be an unexpected finding at laparotomy. Removal of membrane and estimation of the viability of entrapped bowel loops is the treatment of choice, which may require resection in the extreme case of gangrene

Design and cost estimation of solar powered reverse osmosis desalination system

Photovoltaic assisted reverse osmosis (PV-RO) has been proven an efficient renewable energy-based desalination technique to provide drinkable water, especially in remote areas. In this manuscript, a simulation based RO design system was adopted to evaluate the desalination performance for three cities of Pakistan, that is, Lahore, Hasil Pur, and Faisalabad. The inlet concentration of Lahore, Hasil Pur, and Faisalabad was reduced from 1495, 2190, and 7683 TDS to 295.44, 237.69, and 241.98 TDS respectively, according to the WHO drinking water recommendations. The RO desalination system was integrated with the photovoltaic system to fulfill the energy requirement for desalination. The energy requirement for the RO system for the working of 10 h/day with the freshwater production rate of 0.80 m3/h for Lahore, Hasil Pur, and Faisalabad is 60, 95, and 311 kWh/month, respectively. According to PVsyst software, the energy demand can be accomplished by installing 9 PV panels in Lahore, 15 PV panels in Hasil Pur, and 40 PV panels in Faisalabad. The simulation results in PVsyst showing that the battery losses will be 52.2% in Lahore, 51.1% in Hasil Pur, and 49% in Faisalabad

Graphical Views of Intuitionistic Fuzzy Double-Controlled Metric-Like Spaces and Certain Fixed-Point Results with Application

In this article, we establish the concept of intuitionistic fuzzy double-controlled metric-like spaces by “assuming that the self-distance may not be zero”; if the value of the metric is zero, then it has to be “a self-distance”. We derive numerous fixed-point results for contraction mappings. In addition, we provide several non-trivial examples with their graphical views and an application of integral equations to show the validity of the proposed results

The Transcriptional Landscape and Hub Genes Associated with Physiological Responses to Drought Stress in Pinus tabuliformis

Drought stress has an extensive impact on regulating various physiological, metabolic, and molecular responses. In the present study, the Pinus tabuliformis transcriptome was studied to evaluate the drought-responsive genes using RNA- Sequencing approache. The results depicted that photosynthetic rate and H2O conductance started to decline under drought but recovered 24 h after re-watering; however, the intercellular CO2 concentration (Ci) increased with the onset of drought. We identified 84 drought-responsive transcription factors, 62 protein kinases, 17 transcriptional regulators, and 10 network hub genes. Additionally, we observed the expression patterns of several important gene families, including 2192 genes positively expressed in all 48 samples, and 40 genes were commonly co-expressed in all drought and recovery stages compared with the control samples. The drought-responsive transcriptome was conserved mainly between P. tabuliformis and A. thaliana, as 70% (6163) genes had a homologous in arabidopsis, out of which 52% homologous (3178 genes corresponding to 2086 genes in Arabidopsis) were also drought response genes in arabidopsis. The collaborative network exhibited 10 core hub genes integrating with ABA-dependent and independent pathways closely conserved with the ABA signaling pathway in the transcription factors module. PtNCED3 from the ABA family genes had shown significantly different expression patterns under control, mild, prolonged drought, and recovery stages. We found the expression pattern was considerably increased with the prolonged drought condition. PtNCED3 highly expressed in all drought-tested samples; more interestingly, expression pattern was higher under mild and prolonged drought. PtNCED3 is reported as one of the important regulating enzymes in ABA synthesis. The continuous accumulation of ABA in leaves increased resistance against drought was due to accumulation of PtNCED3 under drought stress in the pine needles

Phosphodiesterase-1 Inhibitory Activity of Two Flavonoids Isolated from Pistacia integerrima J. L. Stewart Galls.

Pistacia integerrima is one of twenty species among the genus Pistacia. Long horn-shaped galls that develop on this plant are harvested and used in Ayurveda and Indian traditional medicine to make “karkatshringi”, a herbal medicine used for the treatment of asthma and different disorders of respiratory tract. However, until now, the molecular mechanisms of action of “karkatshringi” and its chemical characterization are partially known. This study deals with the isolation and characterization of the active constituents from the methanolic extract of P. integerrima galls and it was also oriented to evaluate in vitro and in silico their potential enzymatic inhibitory activity against phosphodiesterase-1 (PDE1), a well-known enzyme involved in airway smooth muscle activity and airway inflammation. Our results showed that the methanolic extract of P. integerrima galls and some of its active constituents [naringenin (1) and 3,5,7,4′-tetrahydroxy-flavanone (2)] are able in vitro to inhibit PDE1 activity (59.20 ± 4.95%, 75.90 ± 5.90%, and 65.25 ± 5.25%, resp.) and demonstrate in silico an interesting interaction with this enzymatic site. Taken together, our results add new knowledge of chemical constituents responsible for the biological activity of P. integerrima and contextually legitimate the use of this plant in folk medicine

RESPONSE OF SUNFLOWER TO VARIOUS PRE-GERMINATION TECHNIQUES FOR BREAKING SEED DORMANCY

Abstract Seed dormancy is considered to be a serious constraint in sunflower seed production. Viable seeds sometimes do not germinate even in the presence of favorable environmental conditions. Such seeds are suspected to be dormant. The study was conducted under controlled/laboratory conditions during spring 2010 at National Agricultural Research Centre, Islamabad. The objective of the study was to evaluate some techniques to convert a seed from dormant to non-dormant germinable state. Dormant seeds of 21 sunflower hybrids were treated with three hot water treatments (100°/80°C) and four chemicals potassium nitrate, 0.2%, thiourea, 0.5%, ethanol, 25%, acetone, 25% for breaking seed dormancy .The untreated seed was taken as control. Soaking seeds in hot water (80°C) for 15 minutes followed by one day dry and seed treatment with acetone were found to be the most effective and successful techniques in converting the seed from dormant to nondormant state

Hypoglycemic and hypolipidemic effects of Oligomeris linifolia in Alloxan-induced diabetic mice

The current study was focused to evaluate the hypoglycemic and hypolipidemic effect of methanolic extracts of Oligomeris linifolia in Alloxan-induced diabetic mice. Albino mice were orally treated for 15 days with methanolic extract of Oligomeris linifolia at dose of 200 mg/kg body-weight. The antidiabetic effect was analyzed by measuring blood glucose (BG) at 0, 3, 6, 9, 12, and 15 days. Total cholesterol (TC), high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C), Serum Bilirubin (SBR), Alkaline Phosphatase (ALP), Alanine Aminotransferase (ALT), Urea, Creatinine, and triglycerides (TG) levels at sacrifice (day 16) were measured. Glibenclamide (10 mg/kg) was used as standard. Alloxan-induced diabetic mice showed adequate to significant increase in the level of BG, TC, TG, LDL-C, SBR, ALT, ALP, Urea, Creatinine, while HDL-C and body-weight were decreased as compared to control group (non-diabetic mice). Administration of plant methanolic extract to Alloxan-induced dabetic mice at a dose of 200 mg/kg body-weight resulted in a notable decrease in BG, TC, TG, LDL-C, SBR, ALT, ALP, Urea and Creatinine whereas HDL-C level and body-weight were increased markedly after 15 days as compared to diabetic control group. The methanolic extract at the dose of 200 mg/kg, produced similar results compared to group treated with Glibenclamide

Measuring Coverage in MNCH:A Prospective Validation Study in Pakistan and Bangladesh on Measuring Correct Treatment of Childhood Pneumonia

Antibiotic treatment for pneumonia as measured by Demographic and Health Surveys (DHS) and Multiple Indicator Cluster Surveys (MICS) is a key indicator for tracking progress in achieving Millennium Development Goal 4. Concerns about the validity of this indicator led us to perform an evaluation in urban and rural settings in Pakistan and Bangladesh.Caregivers of 950 children under 5 y with pneumonia and 980 with "no pneumonia" were identified in urban and rural settings and allocated for DHS/MICS questions 2 or 4 wk later. Study physicians assigned a diagnosis of pneumonia as reference standard; the predictive ability of DHS/MICS questions and additional measurement tools to identify pneumonia versus non-pneumonia cases was evaluated. Results at both sites showed suboptimal discriminative power, with no difference between 2- or 4-wk recall. Individual patterns of sensitivity and specificity varied substantially across study sites (sensitivity 66.9% and 45.5%, and specificity 68.8% and 69.5%, for DHS in Pakistan and Bangladesh, respectively). Prescribed antibiotics for pneumonia were correctly recalled by about two-thirds of caregivers using DHS questions, increasing to 72% and 82% in Pakistan and Bangladesh, respectively, using a drug chart and detailed enquiry.Monitoring antibiotic treatment of pneumonia is essential for national and global programs. Current (DHS/MICS questions) and proposed new (video and pneumonia score) methods of identifying pneumonia based on maternal recall discriminate poorly between pneumonia and children with cough. Furthermore, these methods have a low yield to identify children who have true pneumonia. Reported antibiotic treatment rates among these children are therefore not a valid proxy indicator of pneumonia treatment rates. These results have important implications for program monitoring and suggest that data in its current format from DHS/MICS surveys should not be used for the purpose of monitoring antibiotic treatment rates in children with pneumonia at the present time