ROLE OF PAP SMEAR TEST: FROM SCREENING TO CURE IN TERTIARY CARE HOSPITAL

OBJECTIVE This study aims to assess the Pap smear screening method’s accuracy in detecting precancerous lesions. METHODOLOGY After fulfilling the inclusion criteria patients were selected, the patient’s bladder was emptied and put in a dorsal position, and Cusco’s speculum was introduced after lubrication followed by insertion of Ayer’s spatula, applied on the transformational zone, and rotated in 360 degrees. Specimen smeared on glass slides and sent to the laboratory with fulfilled lab pre-requisite form. Patients were requested to follow up with a histopathology report. RESULTS Mean age of the patient was 38.111+9.461 years. Among the 77 patients whose samples were taken 15.4% were asymptomatic, 32.1% with vaginal discharge, 17.9% vaginal discharge,17.0% with intermenstrual bleeding and 16.7% were having lower abdominal pain with p-value=0.087. Histopathology reports were interpreted upon follow-up visit among those 1.3% came out to be positive for malignancy, 76.6% negative for malignancy while 22.1% had an inadequate sample. CONCLUSION The most common method for screening for cervical cancer is the Pap smear, but its efficacy in detecting early precancerous lesions is very low, possibly due to laboratory error or false technique to a gynecologist of sample technique in our tertiary care hospital. Other screening methods should be used instead of conventional Pap smear

Role of CXR and HRCT in diagnosing COVID-19, a descriptive cross-sectional study, at a tertiary care hospital in Pakistan

ABSTRACT Objectives: Objectives of this study are to do the analysis of chest X-ray and High-resolution CT scan findings in patients who are clinical suspects of COVID-19 infection. The other objective is to classify the radiological findings in mild, moderate or severe diseases according to BSTI criteria for chest X-ray and CTSS for high-resolution CT scan. Methods: This is a cross-sectional descriptive study. A group of 50 patients who were clinically suspected cases of COVID-19 infection, presented to Corona flu filter clinic of Holy Family Hospital (HFH) or admitted to corona isolation wards were included. The time duration of the study was from 15 May 2020 to 15 June 2020. Patients labelled as clinically suspected cases were having positive contact with confirmed positive (based upon positive PCR) patients. Recent travel history from the area having an outbreak. They were having clinical signs/symptoms of fever, cough, and shortness of breath, lethargy and loss of sense of smell or taste. CXR and HRCT was the investigation of choice for all the 50 patients.  I also did PCR to make a correlation with the other two tests. All radiological findings were analyzed based upon Fleischner society glossary of terms for thoracic imaging. Two radiologists then assessed CXRs findings based upon BSTI criteria. They marked those CXR findings as low, moderate and high probability for COVID-19 infection. HRCT findings were analyzed using CT-SS, and researchers labelled outcomes as mild, moderate and severe disease.  Results: Out of 50 patients, 33(66%) were males, and 17(34%) were females. Mean age was 51 with ages ranging from 30-72 years. Presenting complaints were fever in 42(84%) patients, cough in 37(74%), lethargy in 33(66%), shortness of breath in 41(82%) and loss of sense of smell and taste in 21(42%) patients. Out of these 50, 32(72%) were having positive PCR for COVID-19 infection. On CXR 5(10%) patients showed classic findings which were highly probable for COVID-19. 19(38%) patients showed intermediate results for COVID-19, 7(14%) patients had a low probability of COVID-19 infection on CXRS. Out of 50, 19(38%), patients showed normal CXR with no evidence of COVID-19 infection. We did HRCT of the same patients on the same day; it showed 21(42%)patients with mild disease,23(46%)patients with moderate disease and 6(12%)patients with the severe disease according to CTSI.HRCT of 3(6%)patients was ok with no evidence of illness in bilateral lungs.    Conclusion: The role of radiology is crucial in the diagnosis of this viral illness. CXR, with its ability to detect changes of COVID-19 in lungs, should be used as a first-line imaging modality in clinically suspected patients. Moreover, it should also be used for follow up of patients with COVID-19. HRCT is very sensitive in the diagnosis of COVID-19 infection in its milder forms. Due to lack of its widespread availability in countries with inadequate medical facilities, it was not the primary imaging tool/screening tool. Due to risk of infection to radiological staff as well as non-covid-19 patients due to surface contact, due to reduced infection control issues, due to increased burden of ionizing radiations in patients. All these factors limit the role of HRCT as a primary imaging modality for COVID-19 infectio

Drivers and barriers of circular economy business models: Where we are now, and where we are heading

Literature on the circular economy business model (CEBM) has witnessed a sharp upsurge in recent years. Although scholars have investigated CEBM from several perspectives, including the green business model, waste management, digital technology, the supply chain, and the financial impact of CEBM, critical analysis of the extant literature has not attracted scholarly attention. The current systematic literature review (SLR) on CEBM is an attempt to critically analyse and appraise the prior findings by following robust research protocols. We analysed a pool of 126 studies to identify the thematic research areas, recognise the research gaps and present future research agendas. Subsequently, we classified the research themes, namely the drivers of and barriers to CEBM. The paper thus provides a comprehensive assessment of the current state of the art on the drivers and barriers involved in executing CEBM. By identifying existing research gaps and presenting avenues for future research, the SLR illuminates the nuances of CEBM implementation. Moreover, we propose an actor-network theory-based conceptual framework for CEBM implementation for further investigation. We conclude the study by providing the theoretical and practical implications for those attempting to overcome the barriers and address the challenges involved in CEBM implementation.publishedVersionPaid open acces

Drivers and barriers of circular economy business models: Where we are now, and where we are heading

Literature on the circular economy business model (CEBM) has witnessed a sharp upsurge in recent years. Although scholars have investigated CEBM from several perspectives, including the green business model, waste management, digital technology, the supply chain, and the financial impact of CEBM, critical analysis of the extant literature has not attracted scholarly attention. The current systematic literature review (SLR) on CEBM is an attempt to critically analyse and appraise the prior findings by following robust research protocols. We analysed a pool of 126 studies to identify the thematic research areas, recognise the research gaps and present future research agendas. Subsequently, we classified the research themes, namely the drivers of and barriers to CEBM. The paper thus provides a comprehensive assessment of the current state of the art on the drivers and barriers involved in executing CEBM. By identifying existing research gaps and presenting avenues for future research, the SLR illuminates the nuances of CEBM implementation. Moreover, we propose an actor-network theory-based conceptual framework for CEBM implementation for further investigation. We conclude the study by providing the theoretical and practical implications for those attempting to overcome the barriers and address the challenges involved in CEBM implementation.publishedVersio

Blockchain for Revitalizing Trade Finance: Enhancing Governance and Minimizing Risks

International trade thrives on the unimpeded flow of trade finance. However, trade finance in its traditional form is itself hindered by several factors, such as heavy reliance on the network of financial institutions, including trade finance organizations, banks, and syndicates of different trading nations. This makes the trade financing process complex, inefficient, unsafe, and unreliable. Against this backdrop, the present study aims to examine how blockchain-based governance can improve trade finance operations by making them not only transparent and accountable but also less risky. This study draws upon institutional theory to delve into pertinent aspects of the use of blockchain-based governance for managing trade finance. The findings are expected to reveal how inherent affordances of blockchain such as transparency can mitigate the systemic issues in the traditional approach to make trade finance more sustainable. The study’s findings are further expected to offer actionable insights for advancing theory and practice in the area

Tacrolimus-associated posterior reversible Encephalopathy syndrome in allogenic Hematopoietic stem cell transplant

Tacrolimus is an immunosuppressive drug used to lower the risk of transplant rejection in individuals after solid organ or hematopoietic transplantation. Cases of posterior reversible encephalopathy syndrome (PRES) as a complication of tacrolimus therapy are infrequently documented. The pathogenesis of this phenomenon is not well understood. Here, we report a case of an 18-year-old female with a history of acute myeloid leukemia that developed PRES after undergoing an allogeneic stem cell transplant and subsequent immunosuppressive therapy with tacrolimus

Frequency of Hyperlipedemia in Patients Coming with Ischemic Stroke in Tertiary Care Hospital Karachi

Background and objective: Stroke is the second leading cause of death and the third leading cause of disability. This study was designed to determine the frequency of hyperlipidemia in patients with ischemic stroke visiting at a tertiary care hospital in Karachi. Methods:This was a descriptive cross-sectional study and was done in Department of Medicine, LCMD/ Dar-ul-Sehat Hospital Karachi, Pakistan. A total of 184 patients were studied during the study period of six months and all the consecutive patients were recruited who presented with acute stroke in the department of medicine from the duration April 1st 2022 to September 30th, 2022.Those fulfilling the inclusion criteria for this study were included for data analysis, while the patients who did not meet the said criteria were excluded. Their serum lipid levels were collected within 24 hours of admission. Hyperlipidemia was measured through fasting lipid profile and was labeled as present if any one or more of the following profile like total cholesterol \u3e200 mg/dl, LDL cholesterol \u3e 100 mg/dl, TGL \u3e 150 mg/dl, HDL cholesterol \u3c 40 mg/dl, as appropriate. Results:The mean age of the patients was 65.17±12.73. Average systolic and diastolic blood pressure was 152.34±21.31 & 83.35±13.71 mm Hg respectively. Mean duration of smoking and diabetes mellitus in first ever ischemic stroke patients was 9.33±4.03 & 13.65±5.8 years respectively, whereas average fasting blood sugar was found 151.98±69.73mg/dl; 118 (64%) were males and 66 (36%) were females. A total of 124 (67.4%) of patients had a history of hypertension, while 94 (51.1%) were diabetic. Fifty-three (28.8%) of patients had a history of coronary artery disease while 22 (11.95%) patients had history of smoking. Increased triglycerides level was seen in 47 (25. 5%). The frequency of hyperlipidemia was 145 (79%) patients respectively. Conclusion: Frequency of hyperlipidemia was 145 (79%) in patients with ischemic stroke which is moderately high in our setup. A high prevalence of hyperlipidemia is alarming in our setup and requires attention of the physicians on modifiable risk factors

Blockchain post-implementation analysis in reverse logistics from a strategic alignment lens

Blockchain technology (BCT) has the potential to transform strategic alliances for reverse logistics, yet its specific impact on sustainability remains unclear. This study aims to ascertain the post-implementation impact of BCT-based strategic alliances on information technology reverse logistics. Drawing on a qualitative research design, it presents a preliminary understanding of BCT-based strategic alliances (i.e., collaborations) in reverse logistics. To address this study’s research question, a conceptual framework based on a prior literature review is proposed to guide qualitative data collection. Next, the study analyzes the respondents’ voices considering the dynamic capability perspective. Sustainability realization is viewed as the main driver for reverse logistics alliances, and the study explores these alliances’ capabilities for sustainability through BCT technology. The study findings significantly contribute to the BCT literature in reverse logistics by assessing BCT-based strategic alliances in reverse logistics and realizing sustainability

Efficacy of Unani Formulation in Patients With GERD: A Case Series

abstract   Objective: Gastro-oesophageal reflux disease (GERD) is defined as the backward flow of gastric contents into the oesophagus. A small amount of reflux occurs in normal individuals. It is a common disease with a prevalence as high as 10% - 20% in the western world. The disease may develop typical, atypical oesophageal and extra-oesophageal symptoms, complications, and can adversely affect an individual's quality of life. Management of GERD may involve lifestyle modification, medical therapy with PPIs, and anti - reflux surgery. But this is having adverse effects. So, the present study aims to assess the safety and efficacy of unani formulation in the treatment of GERD.    Material & Methods: We conducted this study on ten clinically diagnosed cases of GERD attending the Moalejat OPD at AKTCH, AMU Aligarh.   Results: All the symptoms like heartburn, regurgitation, nausea, water brash, sleeplessness were significantly improved after the 45 days treatment with this Unani formulation. The result was analyzed and shown on Likert’s scale.   Conclusion: The preliminary findings indicate that this Unani drug formulation is effective in patients with GERD.   Key words: GERD, Unani formulation, PPIs