Willingness to pay to improve air quality: a study of private vehicle owners in Klang Valley, Malaysia

The growing number of private passenger vehicles in the Klang region of Malaysia has not only resulted in persistent traffic congestion during peak hours, but also resulted in considerable vehicular emissions causing both environmental and human health hazards. To reduce these externalities, this study examines the prospect for a transport modal shift from the use of private vehicles to the public transport system. Contingent valuation method was used to estimate how much current private passenger vehicle users are willing to pay to continue using their private vehicles. On average, private passenger vehicle users were found to be willing to pay a maximum amount of RM 4.99 (USD 1.55) per trip to avoid using the public transport system. Respondents with previous health issues were found more likely to shift to the public transportation system. Public transportation efficiency was found to have a significant impact on the respondents WTP value to maintain the current commuting system

Antibiotic Sensitivity Patterns of Uropathogens in Children: The Current Trend

Background: The emergence of antibiotic-resistant infections has led to increased health care costs and mortality among children. The purpose of this study was to determine the causative organisms responsible for urinary tract infection and their antibiotic sensitivity pattern among pediatric patients of Rawalpindi/Islamabad. Material and Methods: This cross-sectional study was carried out from June 2014 to June 2015, in the Department of Microbiology, Army Medical College, Rawalpindi, affiliated with the Military Hospital, Rawalpindi. About 270 urine samples of children with UTI were analyzed through Analytical Profile Index (API) 20E and biochemical test strips system. Their antibiotic susceptibility was determined by using standard techniques. Data were assessed and analyzed by SPSS version 17. Results: Most common uropathogen was Escherichia coli (61.48%), followed by Proteus (15.5), Klebsiella (12.3%), Pseudomonas (4.5%), Enterococcus (3.7%) and Enterobacter (2.5%). Gram-negative rods, were most sensitive to imipenem (100%), Gentamycin (86%) and Amikacin (78.3%). They were least sensitive to Ampicillin (4.2%) and Norfloxacin (5.5%). Gram-positive cocci showed highest sensitivity for Vancomycin (100%) while displayed relatively less sensitivity for Nitrofurantoin (61.2%) and Gentamycin (48.7%). Cephalosporins also showed increased resistance with only 14% of gram-negative rods showing sensitivity to Cefotaxime. These organisms were highly resistant to Penicillin, showing a sensitivity of only 12.4%. Conclusion: Decreased sensitivity against penicillin and cephalosporins is seen in uropathogens causing UTI in children. High sensitivity towards Nitrofurantoin makes this drug an empirical treatment in UTI.  Regular surveillance of the developing resistance in uropathogens due to inappropriate use of antibiotic is necessary to reduce complication in children with urinary tract infection

Spectrum of Breast Diseases in a Breast Clinic of a Tertiary Care Hospital

Background: To determine the pattern and clinical presentation of breast diseases in different age groups presenting to a breast clinic. Methods: It was a retrospective descriptive study which included all patients presenting to a breast clinic for three years. Age at presentation, symptoms, clinical features, investigations, operative findings and specimen reports were recorded and submitted for analysis. . Results: A total of 3568 patients were included. Mastalgia was the commonest findings (39.42%) followed by fibroadenoma(15.83%) and carcinoma of breast (12.61%). Pain in the breast was the commonest presenting symptom (40.38%). Lump in the breast was found in 22.84%, while pain and lump were present in 27.27% of patients. Among carcinoma breast, intra ductal carcinoma was the commonest (57.55%) followed by malignant phyllodes tumour (17.77%). Conclusion: Most common breast diseases presenting in our setting are mastalgia, fibroadenoma and breast carcinoma. Dedicated breast clinic in our public sector hospitals is need of time. It will help to create awareness about breast diseases among general public and will be a source to collect data about disease burden so that future policies can be streamline

A Rare Cause of Abdominal Pain in Adults: Meckel’s Diverticulitis

A 42-year-old man presented to the emergency room with complaints of periumbilical abdominal pain. A contrast-enhanced computed tomography revealed mucosal thickening in the small bowel of the right abdomen. There was a fairly large small bowel diverticulum associated with this segment. Findings were suggestive of small bowel diverticulitis or possibly focal enteritis. A Meckel’s diverticulum scan was diagnostic of Meckel’s diverticulum. The patient was then immediately taken to the operating room for emergency laparotomy and was intra-operatively found to have a thickened Meckel’s diverticulitis with adjacent small bowel obstruction. Meckel’s diverticulectomy was performed in continuity with the adjacent inflamed small bowel. The patient had a stable postoperative course without any complications and was discharged within 10 days. At the 3-month follow-up, the patient was well and remained asymptomatic

The Blockade Imposed Against Qatar: An Analytical Study of WTO Principles

تسلط هذه الدراسة التحليلية الضوء على النتائج الناجمة عن الحصار المفروض على دولة قطر وانتهاك دول الحصار — المملكة العربية السعودية. دول الإمارات العربية المتحدة، البحرين ومصر- للاتفاقيات التجارية والاقتصادية تحت منطمة التجارة العالمية (WTO). كما أنها تركز على الأسس القانونية للشكاوى التي رفعتها دولة قطر ضد المملكة العربية السعودية. دول الإمارات العربية المتحدة والبحرين. وإجراءات تسوية المنازعات والسلطه القانونية لمنظمة التجارة العالمية (WTO). والاستثناءات الخاصة بالأمن الوطني. فضلا عن المبادئ الأساسية لمعاهدات منطمه التجارة العالمية (WTO) بما فيها الاتفاقية العامة للتعرفة والتجارة الدولية (GATT). الاتفاقية العامة للتجارة في الخدمات (GATS) واتفاقية حقوق الملكية الفكرية المتعلقة بالتجارة (TRIPS).This analytical study sheds light on the consequences of the blockade imposed against Qatar and the violation of the blockading countries – the Kingdom of Saudi Arabia (KSA), the United Arab Emirates (UAE), Bahrain, and Egypt – of trade and economic agreements under the World Trade Organization (WTO). It also focuses on the legal basis of Qatar’s filed complaints against KSA, UAE, and Bahrain, WTO’s Dispute Settlement Procedures and jurisdiction, and the national security exceptions, as well as the main principles of the WTO treaties including General Agreement on Tariffs and Trade (GATT), General Agreement on Trade in Services (GATS), and Trade-Related Aspects of Intellectual Property Rights (TRIPS)

Infections in patients with multiple myeloma treated with conventional chemotherapy: A single-center, 10-year experience in Pakistan

Introduction: Multiple myeloma (MM) is a common hematologic malignancy with variable degrees of immunodeficiency. Disease- and treatment-related compromise of the immune system predisposes patients to infections, which are a major cause of morbidity and mortality.Objective: We aimed to establish the incidence and main characteristics of infections in MM patients treated at our center over a 10-year period.Method and results: Of the 412 patients retrospectively analyzed, 154 (37.4%) were documented to have at least one episode of infection and were included in this study. A total of 244 infectious episodes were documented. The most common site of infection was the lung, followed by the genitourinary system. The most common infections were bacterial, followed by viral. Escherichia coli were the most common organism. In 160 (65.5%) episodes, the organism was not isolated. Thalidomide with dexamethasone was the most common treatment regimen, followed by melphalan with dexamethasone. Infection was the main cause of death in 26 (6.3%) out of all 412 patients.Conclusion: Infections are a notable cause of morbidity and mortality in the clinical course of MM patients. By considering patient and disease characteristics, a risk-adapted selection of the MM treatment should be employed, with special attention toward patient age and disease-associated organ dysfunction. Patient education, access to healthcare and physician vigilance are also essential. Vaccination and antimicrobial prophylaxis may be considered prior to or during therapy

Performance of the TIMI risk score in predicting mortality after primary percutaneous coronary intervention in elderly women: Results from a developing country

Background: Despite women undergoing primary percutaneous coronary intervention (PPCI) having a higher rate of adverse outcomes than men, data evaluating prognostic risk scores, especially in elderly women, remains scarce. This study was conducted to validate the predictive value of Thrombolysis in Myocardial Infarction (TIMI) risk score in elderly female patients. Materials and Methods: This was a retrospective analysis of elderly (\u3e65 years) female patients who underwent PPCI for ST-elevated myocardial infarction (STEMI) from October 2016 to September 2018. Patients\u27 demographic details and elements of TIMI risk score including age, co-morbidities, Killip classification; weight, anterior MI and total ischemic time were extracted from hospital records. The primary outcome was in-hospital mortality and post-discharge mortality reported on telephonic follow-up. Results: A total of 404 elderly women with a median age of 70 years were included. The mean TIMI score was 5.25±1.45 with 40.3% (163) patients of TIMI score \u3e 5. In-hospital mortality rate was 6.4% (26) and was found to be associated with TIMI score (p\u3c0.001). The in-hospital mortality rate increased from 3.1% at TIMI score of 0-4 to 34.6% at the score of 8. On follow-up (16.43±7.40 months) of 211 (55.8%) patients, the overall mortality rate was 20.3%, and this was also associated with TIMI score (p\u3c0.001). The mortality rate increased from 5.6% at the score of 0-4 to 54.5% at the score of 8. The predictive values (area under the curve) of TIMI risk score for in-hospital and post-discharge mortality were 0.709 (95% CI 0.591-0.827; p \u3c0.001) and 0.689 (95% CI 0.608-0.770; p \u3c0.001), respectively. Conclusion: Increased adverse outcomes were observed with higher TIMI risk score for in hospital and post-discharge follow-up. Therefore, the prognostic TIMI risk score is a robust tool in predicting both in-hospital as well as post-discharge mortality in elderly females