Outcomes of patients presenting with Cholecystitis in terms of Early vs Delayed Cholecystectomy

Introduction: Biliary tract diseases comprise the most frequently occurring pathology in the abdomen, among which cholelithiasis affects 10-15% of the population.  Early laparoscopic cholecystectomy, performed within 72 hours 2) Interval laparoscopic cholecystectomy, performed within 72 hours to 6 weeks 3) Delayed laparoscopic cholecystectomy in which patients are treated with antibiotics and given date of surgery within 6-8 weeks according to international criteria. Objective: To find out the variability between hot, urgent, and delayed laparoscopic cholecystectomy in terms of clinical complications and to find out the readmission rate, the persistence of symptoms, and the safety of the procedure. Materials and Methods: This is a retrospective study carried out in the Surgical Unit ll, Holy Family Hospital, Rawalpindi from January 2018 to March 2018. All adult male and female patients presenting with acute cholecystitis and pancreatitis were included in the study. Results: Total number of patients included in our study is 82. Most of the patients were female 80.5% with a mean age of 44 years. Most of the patients were categorized under delayed laparoscopic cholecystectomy 93.9%, 6.1% underwent interval/urgent cholecystectomy, and 1.2% early/hot cholecystectomy. Diagnosis in the study showed acute cholecystitis in 79.3% of patients, pancreatitis in 7.3%, empyema /gangrene of gallbladder in 6.1% mucocele in 6.1%, and choledocholithiasis in 1.2% of patients. Hence we figured out that performing early cholecystectomy leads to lesser complications. Conclusion: Early laparoscopic cholecystectomy was found out to be a safe and cost-effective procedure. There is an increased incidence of readmission and complications with delayed laparoscopic cholecystectomy. We suggest that measures must be taken in Pakistan to follow international guidelines in health practices to improve patient care

Ethical leadership, management control systems and circular economy in SMEs in an emerging economy, the UAE

Prior literature on the transition to a circular economy has focused primarily on societal, institutional, and technical levels and has paid less attention to people- and organization-driven factors such as leadership and management control. Further, few studies have considered the circular economy in the context of small and medium enterprises in emerging economies. Thus, through this empirical study, we aim to fill these research gaps by investigating the concurrent effects of ethical leadership and management control systems on the extent of the circular economy in small and medium-sized enterprises in the United Arab Emirates. The survey data were collected from 111 enterprises. We performed a confirmatory factor analysis to validate the instrument and tested the theoretical model through structural equation modelling. The findings support our theoretical propositions and show that both ethical leadership and management control systems are positively associated with the extent of circular economy practices in these enterprises. Interestingly, our findings demonstrate that management control systems fully mediate the relationship between ethical leadership and the extent of the circular economy. The results suggest that ethical leadership requires the support of management control systems to convey its positive effects in terms of circular economy practices. Overall, the findings help explain how ethical leadership and management control systems are important driving mechanisms for enabling small and medium enterprises to deploy a circular economy effectively. The implications of these findings for research and practice are also discussed

A homozygous Keap1-knockout human embryonic stem cell line generated using CRISPR/Cas9 mediates gene targeting

Kelch-like ECH-associated protein 1 (keap1) is a cysteine-rich protein that interacts with transcription factor Nrf2 in a redox-sensitive manner, leading to the degradation of Nrf2 (Kim et al., 2014a). Disruption of Keap1 results in the induction of Nrf2-related signaling pathways involving the expression of a set of anti-oxidant and anti-inflammatory genes. We generated biallelic mutants of the Keap1 gene using a CRISPR-Cas9 genome editing method in the H9 human embryonic stem cell (hESC). The Keap1 homozygous-knockout H9 cell line retained normal morphology, gene expression, and in vivo differentiation potential. (C) 2016 The Author(s). Published by Elsevier B.V.

Knowledge, attitudes and practices survey on organ donation among a selected adult population of Pakistan

Background: To determine the knowledge, attitudes and practices regarding organ donation in a selected adult population in Pakistan. Methods: Convenience sampling was used to generate a sample of 440, 408 interviews were successfully completed and used for analysis. Data collection was carried out via a face to face interview based on a pre-tested questionnaire in selected public areas of Karachi, Pakistan. Data was analyzed using SPSS v. 15 and associations were tested using the Pearson\u27s Chi square test. Multiple logistic regression was used to find independent predictors of knowledge status and motivation of organ donation. Results: Knowledge about organ donation was significantly associated with education (p = 0.000) and socioeconomic status (p = 0.038). 70/198 (35.3%) people expressed a high motivation to donate. Allowance of organ donation in religion was significantly associated with the motivation to donate (p = 0.000). Multiple logistic regression analysis revealed that higher level of education and higher socioeconomic status were significant (p \u3c 0.05) independent predictors of knowledge status of organ donation. For motivation, multiple logistic regression revealed that higher socioeconomic status, adequate knowledge score and belief that organ donation is allowed in religion were significant (p \u3c 0.05) independent predictors. Television emerged as the major source of information. Only 3.5% had themselves donated an organ, with only one person being an actual kidney donor. Conclusion: Better knowledge may ultimately translate into the act of donation. Effective measures should be taken to educate people with relevant information with the involvement of media, doctors and religious scholars

Development of a protocol to investigate the stability of drugs used by Qatar's National Ambulance Service in rapid response vehicles

Background: Paramedics need a range of medications that are stored in bags for easy transportation to the patient's side and are exposed to temperature variations, especially in a hot country like Qatar 1 . The thermal stability of some medications was examined in previous studies 2,3 . Methods: A safe and practical solution had to be found and should be approved by the Production committee to investigate the thermal stability of a range of 13 medications over different periods of time (Table 1). Results: Six medication bags have been specially prepared with the drug samples presented in Table 1. While one data logger was fixed to the metal net divider at the back of the rapid response vehicle, each bag contained a radio-frequency identification (RFID) tag for tracing, two data loggers to measure the temperature and humidity every 10 minutes over a 3 to 12-month period, and an initial total of 15 drug samples (Table 1). The bags have been labeled “For research purpose” and placed at the back of rapid response vehicles (Figure 1). At collection times, 3 samples of each medication will be removed for analysis and replaced by new samples. Similarly, data loggers will be collected and replaced with new ones. As per Qatar Ambulance Service's standard operating procedures, paramedics are required to always keep their medication bag with them when they leave their vehicle for a break or to treat a patient, but for practical and safety reasons it will not be the case with the research samples. Although this means that the research bags will have less exposure to the outdoor environment, they will still be subjected to temperature variation in case the vehicle is parked without air conditioning 1 . The collected samples will be kept at 4°C until analyzed by high-performance liquid chromatography. Conclusion: Based on the findings of this study, the results may have a significant impact on how some of the drugs are handled in the pre-hospital setting, especially, possible modification of the recommended expiration date specified by manufacturers to ensure patient safety

In situ functional dissection of RNA cis-regulatory elements by multiplex CRISPR-Cas9 genome engineering.

RNA regulatory elements (RREs) are an important yet relatively under-explored facet of gene regulation. Deciphering the prevalence and functional impact of this post-transcriptional control layer requires technologies for disrupting RREs without perturbing cellular homeostasis. Here we describe genome-engineering based evaluation of RNA regulatory element activity (GenERA), a clustered regularly interspaced short palindromic repeats (CRISPR)-Cas9 platform for in situ high-content functional analysis of RREs. We use GenERA to survey the entire regulatory landscape of a 3'UTR, and apply it in a multiplex fashion to analyse combinatorial interactions between sets of miRNA response elements (MREs), providing strong evidence for cooperative activity. We also employ this technology to probe the functionality of an entire MRE network under cellular homeostasis, and show that high-resolution analysis of the GenERA dataset can be used to extract functional features of MREs. This study provides a genome editing-based multiplex strategy for direct functional interrogation of RNA cis-regulatory elements in a native cellular environment

D2D-V2X-SDN: Taxonomy and Architecture towards 5G Mobile Communication System

In the era of information society and 5G networks, cars are extremely important mobile information carriers. In order to meet the needs of multi-scenario business requirements such as vehicle assisted driving and in-vehicle entertainment, cars need to interact with the outside world. This interconnection and data transmission process is usually called vehicular communication (V2X, Vehicle-to-Everything). Device-to-device (D2D) communication not only has partial nature of communication, but also alleviate the current problem of spectrum scarcity of resources. The application of D2D communication in V2X can meet the requirements of high reliability and low latency, but resource reuse also brings interference. Software-defined networking (SDN) provides an optimal solution for interoperability and flexibility between the V2X and D2D communication. This paper reviews the integration of D2D and V2X communication from the perspective of SDN. The state-of-the-art and architectures of D2D-V2X were discussed. The similarity, characteristics, routing control, location management, patch scheduling and recovery is described. The integrated architecture reviewed in this paper can solve the problems of routing management, interference management and mobile management. It also overcome the disconnection problem between the D2D-V2X in terms of SDN and provides some effective solutions.- Qatar National Research Fund (QNRF) - [UREP27-020-1-003]. - Ministry of Higher Education, Malaysia (MOHE) - [FRGS/1/2018/ICT02/UKM/02/6]. - National Research Foundation of Korea (NRF) - [2019R1C1C1007277]. - Taif University (TU)- [TURSP-2020/260]

Methods of induction of labour: a systematic review

<p>Abstract</p> <p>Background</p> <p>Rates of labour induction are increasing. We conducted this systematic review to assess the evidence supporting use of each method of labour induction.</p> <p>Methods</p> <p>We listed methods of labour induction then reviewed the evidence supporting each. We searched MEDLINE and the Cochrane Library between 1980 and November 2010 using multiple terms and combinations, including labor, induced/or induction of labor, prostaglandin or prostaglandins, misoprostol, Cytotec, 16,16,-dimethylprostaglandin E2 or E2, dinoprostone; Prepidil, Cervidil, Dinoprost, Carboprost or hemabate; prostin, oxytocin, misoprostol, membrane sweeping or membrane stripping, amniotomy, balloon catheter or Foley catheter, hygroscopic dilators, laminaria, dilapan, saline injection, nipple stimulation, intercourse, acupuncture, castor oil, herbs. We performed a best evidence review of the literature supporting each method. We identified 2048 abstracts and reviewed 283 full text articles. We preferentially included high quality systematic reviews or large randomised trials. Where no such studies existed, we included the best evidence available from smaller randomised or quasi-randomised trials.</p> <p>Results</p> <p>We included 46 full text articles. We assigned a quality rating to each included article and a strength of evidence rating to each body of literature. Prostaglandin E2 (PGE2) and vaginal misoprostol were more effective than oxytocin in bringing about vaginal delivery within 24 hours but were associated with more uterine hyperstimulation. Mechanical methods reduced uterine hyperstimulation compared with PGE2 and misoprostol, but increased maternal and neonatal infectious morbidity compared with other methods. Membrane sweeping reduced post-term gestations. Most included studies were too small to evaluate risk for rare adverse outcomes.</p> <p>Conclusions</p> <p>Research is needed to determine benefits and harms of many induction methods.</p