Empirical linkages between ICT, tourism, and trade towards sustainable environment: evidence from BRICS countries

There is a growing utilisation of information and communication technologies (ICT) in the recent digital era. Trade and tourism have also attained attention as determinants of environmental sustainability. Therefore, this study investigates linkages between ICT, tourism, trade, economic growth, and environmental sustainability in BRICS economies. Advanced panel estimation entitled cross-sectionally augmented autoregressive distributed lags (CSARDL) was applied from 1990 to 2019. Findings suggest the adverse effect of tourism, trade, and growth factors on environmental sustainability, whereas ICT helps promote a sustainable environment among the targeted economies. Likewise, the shortrun results prove that economic growth and tourism are prone to ecological health, while trade possesses an insignificant influence on ecological sustainability. These results suggest the integration of ICT in trade and tourism sectors to mitigate their negative ecological consequences

Evidence of the Practice of Self-Medication with Antibiotics among the Lay Public in Low- and Middle-Income Countries: A Scoping Review

The current scoping review is an attempt to explore the key reasons, determinants, patterns and prevalence related to self-medication with antibiotics (SMA) among the lay public. An online search was conducted using Google Scholar, Science Direct, ProQuest and PubMed. A two-phase mapping approach was used. In the first phase, studies were screened. In the second phase, the data were extracted from selected studies followed by the assessment of data quality. A total of 24 studies were included; 20 were cross-sectional, 3 were qualitative and one was observational. The most common indications were flu, cough, common colds, sore throat, diarrhea, toothache and fever. The most common determinants reported were past good experience and suggestions from friends or relatives. The use of SMA was observed to be more frequent in younger aged individuals belonging to low- or middle-income groups. The prevalence rate was reported to be high among the South Asian lay public and may be a major contributor to antibiotic resistance. In conclusion, this scoping review identifies a need for education campaigns and mass media campaigns to strengthen lay public awareness about the side effects and risks associated with SMA. In addition to this, there is a need to implement strict policies by government agencies to restrict over the counter availability of antibiotics

Fabrication of miconazole nitrate solid lipid nanoparticle loaded microneedle patches for the treatment of Candida albicans biofilms

The present study aimed to develop miconazole nitrate solid lipid nanoparticle (SLN) loaded polymeric microneedle (MN) patches (SPs) via the vacuum micromolding approach. The SLNs were fabricated through melt emulsification of stearic acid using Tween 80. SPs were prepared using chitosan, gelatin (as base materials) and polyethylene glycol 400 (as a plasticizer). The prepared formulations were evaluated for various physicochemical parameters, including particle size, polydispersity index, encapsulation efficiency, loading capacity (in the case of SLNs), folding endurance, % swelling and insertion ability (in the case of SPs). Scanning electron microscopy and differential scanning calorimetry (DSC) studies were carried out for morphological and thermal analysis, respectively. Phase analysis was carried out via X-ray diffraction (XRD). In vitro tensile strength, drug release, anti-biofilm activity and in vivo anti-biofilm activity were studied to assess the efficiency of the SLN loaded polymeric formulation. Miconazole nitrate containing SLNs appeared as smooth-surfaced aggregates and displayed a particle diameter of ∼224 nm, polydispersity index of ∼0.32, encapsulation efficiency of ∼88.88% and loading capacity of ∼8.88%. SPs exhibited evenly aligned, uniform-surfaced, sharp-tipped projections, with an acceptable folding endurance of ∼300 and % swelling of ∼359%. DSC and XRD results confirmed the incorporation of the drug within the solidified lipid matrix as an amorphous solid. The miconazole nitrate lipidic nanoparticle containing polymeric formulation exhibited a tensile strength ∼1.35 times lower than the pure drug loaded counterpart. During in vitro studies, SPs released ∼94% miconazole nitrate within 150 minutes and reduced the mass of the Candida albicans (C. albicans) biofilm by ∼79%. After 10 days of treatment with SPs, C. albicans infected wounds were healed, confirming that the prepared formulations can be used for the management of fungal biofilms

Effects of a high-dose 24-h infusion of tranexamic acid on death and thromboembolic events in patients with acute gastrointestinal bleeding (HALT-IT): an international randomised, double-blind, placebo-controlled trial

Background: Tranexamic acid reduces surgical bleeding and reduces death due to bleeding in patients with trauma. Meta-analyses of small trials show that tranexamic acid might decrease deaths from gastrointestinal bleeding. We aimed to assess the effects of tranexamic acid in patients with gastrointestinal bleeding. Methods: We did an international, multicentre, randomised, placebo-controlled trial in 164 hospitals in 15 countries. Patients were enrolled if the responsible clinician was uncertain whether to use tranexamic acid, were aged above the minimum age considered an adult in their country (either aged 16 years and older or aged 18 years and older), and had significant (defined as at risk of bleeding to death) upper or lower gastrointestinal bleeding. Patients were randomly assigned by selection of a numbered treatment pack from a box containing eight packs that were identical apart from the pack number. Patients received either a loading dose of 1 g tranexamic acid, which was added to 100 mL infusion bag of 0·9% sodium chloride and infused by slow intravenous injection over 10 min, followed by a maintenance dose of 3 g tranexamic acid added to 1 L of any isotonic intravenous solution and infused at 125 mg/h for 24 h, or placebo (sodium chloride 0·9%). Patients, caregivers, and those assessing outcomes were masked to allocation. The primary outcome was death due to bleeding within 5 days of randomisation; analysis excluded patients who received neither dose of the allocated treatment and those for whom outcome data on death were unavailable. This trial was registered with Current Controlled Trials, ISRCTN11225767, and ClinicalTrials.gov, NCT01658124. Findings: Between July 4, 2013, and June 21, 2019, we randomly allocated 12 009 patients to receive tranexamic acid (5994, 49·9%) or matching placebo (6015, 50·1%), of whom 11 952 (99·5%) received the first dose of the allocated treatment. Death due to bleeding within 5 days of randomisation occurred in 222 (4%) of 5956 patients in the tranexamic acid group and in 226 (4%) of 5981 patients in the placebo group (risk ratio [RR] 0·99, 95% CI 0·82–1·18). Arterial thromboembolic events (myocardial infarction or stroke) were similar in the tranexamic acid group and placebo group (42 [0·7%] of 5952 vs 46 [0·8%] of 5977; 0·92; 0·60 to 1·39). Venous thromboembolic events (deep vein thrombosis or pulmonary embolism) were higher in tranexamic acid group than in the placebo group (48 [0·8%] of 5952 vs 26 [0·4%] of 5977; RR 1·85; 95% CI 1·15 to 2·98). Interpretation: We found that tranexamic acid did not reduce death from gastrointestinal bleeding. On the basis of our results, tranexamic acid should not be used for the treatment of gastrointestinal bleeding outside the context of a randomised trial

The development and validation of a scoring tool to predict the operative duration of elective laparoscopic cholecystectomy

Background: The ability to accurately predict operative duration has the potential to optimise theatre efficiency and utilisation, thus reducing costs and increasing staff and patient satisfaction. With laparoscopic cholecystectomy being one of the most commonly performed procedures worldwide, a tool to predict operative duration could be extremely beneficial to healthcare organisations. Methods: Data collected from the CholeS study on patients undergoing cholecystectomy in UK and Irish hospitals between 04/2014 and 05/2014 were used to study operative duration. A multivariable binary logistic regression model was produced in order to identify significant independent predictors of long (> 90 min) operations. The resulting model was converted to a risk score, which was subsequently validated on second cohort of patients using ROC curves. Results: After exclusions, data were available for 7227 patients in the derivation (CholeS) cohort. The median operative duration was 60 min (interquartile range 45–85), with 17.7% of operations lasting longer than 90 min. Ten factors were found to be significant independent predictors of operative durations > 90 min, including ASA, age, previous surgical admissions, BMI, gallbladder wall thickness and CBD diameter. A risk score was then produced from these factors, and applied to a cohort of 2405 patients from a tertiary centre for external validation. This returned an area under the ROC curve of 0.708 (SE = 0.013, p  90 min increasing more than eightfold from 5.1 to 41.8% in the extremes of the score. Conclusion: The scoring tool produced in this study was found to be significantly predictive of long operative durations on validation in an external cohort. As such, the tool may have the potential to enable organisations to better organise theatre lists and deliver greater efficiencies in care

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

Primary hyperoxaluria in populations of Pakistan origin: results from a literature review and two major registries

Primary hyperoxalurias (PH) are devastating, autosomal recessive diseases causing renal stones. Undifferentiated hyperoxaluria is seen in up to 43% of Pakistani paediatric stone patients. High rates of consanguinity in Pakistan suggest significant local prevalence. There is no detailed information regarding number of cases, clinical features, and genetics in Pakistan-origin (P-o) patients. We reviewed available information on P-o PH patients recorded in the literature as well as from two major PH registries (the Rare Kidney Stone Consortium PH Registry (RKSCPHR) and the OxalEurope PH Registry (OxER); and the Aga Khan University Hospital in Pakistan. After excluding overlaps, we noted 217 P-o PH subjects (42 in OxER and 4 in RKSCPHR). Presentations were protean. Details of mutations were available for 94 patients of 201 who had genetic analyses. Unique mutations were noted. Mutation [c.508G\u3eA (p. Gly170Arg)] (present in up to 25% in the West) was reported in only one case. In one series, only 30% had mutations on exons 1,4,7 of AGXT. Of 42 P-o patients in OxER, 52.4% were PH1, 45.2% PH2, and 2.4% PH3. Of concern is that diagnosis was made after renal transplant rejection (four cases) and on bone-marrow aspiration (in five). Lack of consideration of PH as a diagnosis, late diagnosis, and loss of transplanted kidneys mandates that PH be searched for diligently. Mutation analysis will need to extend to all exons and include PH 1,2,3. There is a need to spread awareness and identify patients through a scoring or screening system that alerts physicians to consider a diagnosis of PH

Impact of heat stress on agro-morphological, physio-chemical and fiber related paramters in upland cotton (Gossypium hirsutum L.) genotypes

The unpredictably changing climatic conditions, especially high temperatures, are putting a continuous threat to sustainable cotton production. The current study was designed to investigate the impact of heat stress on several morpho-physiological, biochemical, and fibre quality-related traits. The results revealed the presence of significant variations in agro-morphological, physio-chemical and staple length-related parameters for upland cotton genotypes and stress treatments. Further analysis of pooled data unveiled that heat stress had a detrimental impact on all studied plant traits. Severe reduction in plant height, nodes per plant, sympodial branches per plant, number of bolls per plant, ginning out-turn, and staple length were recorded under heat stress. A significant reduction in net photosynthetic rate (Pn) up to 28.6 % was observed in cotton genotype BH-200 (24.7 to 19.2 µmole m−2 s−1). The accumulation of hydrogen peroxide (H2O2) was increased from 7.1 % in BH-306 to 28.7 % in BH-200 under heat stress due to the incidence of oxidative stress. A substantial increase in the accumulation of antioxidants i.e., catalase (65 %–74 %), peroxidase (54 %–169 %), and superoxide dismutase (52 %–98 %) was seen under high-temperature stress conditions. The correlation coefficient analysis unveiled a significantly positive correlation of seed cotton yield with nodes per plant (r = 0.432*), net photosynthetic rate (r = 0.829**), peroxidase (r = 0.974**), and superoxide dismutase (r = 0.868**), under heat stress conditions. However, a negative but statistically significant correlation of seed cotton yield with ginning out turn (r = −0.466*), staple length (r = −0.898**), hydrogen peroxide (r = −0.955**) and catalase (r = −0.904**) was also observed. The overall results unveiled that cotton genotype BH-232 has a comparatively higher heat tolerance than other contesting genotypes while BH-306 showed the highest susceptibility to heat stress. Hence, BH-232 could be recommended after its approval for general cultivation in heat-prone areas of Pakistan