Organizational Performance and Entrepreneurial Orientation: The Intervening Role of Organizational Learning

Many past studies have examined the association between entrepreneurial orientation (E.O.) and organizational performance (O.P.). However, these studies have not adequately addressed the mediating roles of acquisition learning (A.L.) and experiential learning (E.L.) on organizational performance. Given this gap, we have developed a new model that contains six direct relationships, three mediating relationships, and one multi-mediating relationship. The focus of the study was on Indonesian Pharmaceutical SMEs. We have collected a sample of 365 respondents non-randomly. For statistical analysis, we have used Smart PLS version 3.2. The statistical analysis includes reliability, validity, and descriptive statistics. The results confirm that acquisition learning (A.L.), experiential learning (E.L.), and entrepreneurial orientation (E.O.) promote organizational performance (O.P.). We also found that entrepreneurial orientation (E.O.) impacts acquisition learning (A.L.) and innovative performance (I.P.) but does not affect organizational performance (O.P.). However, the results suggest that acquisition learning (A.L.) and experiential learning (E.L.) are positively linked. Our results also support all the mediating relationships

Endoscopic management of biliary leaks after open and laparoscopic cholecystectomy

Objective: To evaluate the diagnostic and therapeutic efficacy of ERCP in the management of biliary leaks.Methods: The study recruited 35 out of total 436 ERCP patients with post surgical biliary leaks, who presented to our department between January 1, 2001 and September 30, 2004. Unsuccessful ERCP and/or completely transected CBD injuries were handed over to surgery.Results: ERCP was successful in 33 (94%) patients. Of these 25 (75%) had cystic stump leaks, 3 (9%) had transected CBD, 2 (6%) had leakage from gall bladder (GB) bed, 2 (6%) had persistently draining T-tube with retained CBD stones and one (3%) patient had a leak from the right hepatic duct. CBD stenting was done successfully in 23 (92%) patients with a cystic stump leak. The other 3 patients with leakage from GB bed and right hepatic duct injury were successfully dealt with CBD stenting. The retained CBD stones were endoscopically removed. The overall therapeutic success was 93% and stents were removed after 6-8 weeks without further complications. Three patients with transected CBD were treated surgically.CONCLUSION: latrogenic Biliary system Injuries can be diagnosed and managed efficiently through Endoscopic Retrograde Cholangiopancreatography (ERCP)

OUTCOME OF ENDOSCOPIC THERAPEUTIC INTERVENTIONS: ARE THEY DIFFERENT AMONG VARIOUS NON- MALIGNANT ESOPHAGEAL DISEASES

Background: This study was carried out to evaluate and compare the outcome of various causes of non-malignant lesions of the esophagus after endoscopic therapeutic intervention. Methods: A cohort of patients with non-malignant dysphagia presenting at Aga Khan University hospital, a tertiary care setting who underwent endoscopic intervention was studied. Response to treatment was evaluated by improvement in dysphagia score on a scale of 0-4 and weight gain. Results:99 subjects (53 males) were included. Mean age was 48.6 +/- 17.2 years. Dysphagia for solids was present in 48%, for liquids in 3% and for both in 49% patients. Significant weight loss (\u3e10% body weight) occurred in 35 (35.3%) patients. Achalasia was diagnosed in 49.5%, peptic stricture in 30.4%, post sclerotherapy stricture in 12.1%, corrosive injury in 4%, post-operative stricture in 4%. In comparative analysis of achalasia and inflammatory groups, good response to dysphagia was seen in 40/49 (82%) and 22/50 (44%) respectively p \u3c 0.001. Weight gain was 35/49 (72%) and 22/50 (44%) p Conclusion: Dysphagia and weight loss were common presentations in non-malignant esophageal diseases. Therapeutic intervention in inflammatory group was associated with high complication than the achalasia group

Varied presentation of celiac disease in Pakistani adults

he objective of this retrospective study was to evaluate presentation of celiac disease in adults. It included 77 patients, 41 (53.2%) males with median age 26 years and median body mass index of 18 (16 � 22) kg/m2. Typical presentation with gastrointestinal symptoms was seen in 76.6%. Atypical presentation with extra intestinal complaints in 7.8% and silent presentation in 15.6%. Major symptoms were diarrhea in 64.9%, weight loss 36.4%, abdominal pain 35.1%, vomiting 32.5%, pallor 24.7%, and weakness 13%. Iron deficiency was documented in 20.8%, B12 deficiency in 9.1%, folic acid deficiency in 6.5% and vitamin D deficiency in 10.4%. Half of the patients had haemoglobin less than 11 g/dl. Osteoporosis and osteomalacia, hypothyroidism, diabetes and atrophic gastritis were seen in 2.6% each. Raised alanine aminotransferase was documented in 23.4%. Duodenal biopsy, done in 39 patients, revealed increased intraepithelial lymphocytes in 11, along with crypt hyperplasia in 3, partial villous atrophy in 15 and sub-total villous atrophy in 10. In conclusion, celiac disease in adults should be looked for in patients with chronic diarrhea or irritable bowel syndrome like symptoms, underweight, anaemic, or having nutritional deficiencies

Short course adjuvant terlipressin in acute variceal bleeding: A randomized double blind dummy controlled trial

Background & Aims: Terlipressin is recommended for 3-5 days as adjuvant to endoscopic variceal band ligation (EVBL) in esophageal variceal bleeding (EVB). We assessed whether terlipressin can be administered for a shorter period of time to Patients with EVB. Methods: All eligible EVB Patients received 24 h of open label terlipressin at presentation. After successful EVBL, Patients were randomized to receive active or dummy terlipressin for the next 48 h. We excluded Patients with failure to achieve initial hemostasis, bleeding gastric varices, known hepatoma, and/or portal vein thrombosis, advanced cirrhosis (Child-Pugh score \u3e= 12), and Patients on a ventilator. The primary outcome was failure to control EVB. The secondary outcomes were 30-day mortality, re-bleeding and composite outcome of failure to control EVB. Results: A total of 130 eligible Patients were randomized to receive terlipressin for a total of 24 (short course or SC) or 72 h (usual course or UC). Baseline Patient characteristics were comparable, the majority of Patients were HCV-infected and male. There was one failure to control EVB (1.5%) in UC and none in SC terlipressin (p = 0.50). The 30-day re-bleeding rate was 1.5% and 3.1% in UC, and SC terlipressin, respectively (p = 0.50). The 30-day mortality was 12, 6 (9.2%) Patients in each group (p = 0.50). The 30-day failure to control bleeding was observed in 14 Patients, seven in each group (p = 0.494). Conclusions: In Patients with esophageal variceal bleeding, a 24-h course of terlipressin is as effective as a 72-h course when used as an adjunctive therapy to successful EVBL

Efficacy of L-ornithine-L-aspartate as an adjuvant therapy in cirrhotic patients with hepatic encephalopathy

OBJECTIVE: To evaluate the efficacy of L-ornithine-L-aspartate (LOLA) as an adjuvant therapy in cirrhotic patients with hepatic encephalopathy (HE). STUDY DESIGN: Randomized placebo controlled study. PLACE AND DURATION OF STUDY: The Aga Khan University Hospital, Karachi in the year 2003-2004. METHODOLOGY: Patients with HE were randomized to receive LOLA or placebo medicine as an adjuvant to treatment of HE. Number connection test-A (NCT-A), ammonia level, clinical grade of HE and duration of hospitalization were assessed. RESULTS: Out of 120 patients, there were 62 males with mean age of 57 11 years. Improvement in HE was higher (n=40, 66.7%) in LOLA group as compared to the placebo group (n=28, 46.7%, p=0.027). In patients with grade I or less encephalopathy, improvement was seen in 6 (35.3%) and 3 (20%) patients in LOLA and placebo groups respectively (p=0.667). Patients with HE grade II and above showed improvement in 34 (79.1%) and 25 (55.6%) cases in LOLA and placebo group respectively (p=0.019). On multivariate analysis patients with HE of grade II and above showed prothrombin time, creatinine level and use of LOLA influencing the outcome. Duration of hospitalization was 93.6 25.7 hours and 135.2 103.5 hours in LOLA and placebo groups respectively (p=0.025). No side effects were observed in either groups. CONCLUSION: In cirrhotic patients with advanced hepatic encephalopathy treatment with LOLA was safe and associated with relatively rapid improvement and shorter hospital stay

Sclerotherapy plus octreotide versus sclerotherapy alone in the management of gastro-oesophageal variceal hemorrhage

Background: There are different ways for controlling oesophageal variceal bleed which include pharmacological and endoscopic methods. In this study we compare efficacy of octreotide (50 g/hr for 48 hours) combined with sclerotherapy versus sclerotherapy alone in patients with acute bleeding from gastro-oesophageal varices (GOV).Methods: It was a randomized clinical controlled trial conducted at Aga Khan University Hospital, Karachi, from January 1997 to December 1998. We evaluated the role of octreotide (50 g/hr for 48 hours) combined with sclerotherapy versus sclerotherapy alone in a total of 105 adult cirrhotic patients who had acute bleeding from GOV. Patients were assigned to receive octreotide plus sclerotherapy or sclerotherapy alone. Primary outcome measure was 5-day survival without rebleeding. The hospital stay in days and blood transfusion requirements were also compared in the combined treatment group versus sclerotherapy alone group.Results: Initial control of bleeding was achieved in 46/51 (90.2%) patients who received combined treatment compared to 41/54 (75.9%) patients (p = 0.05) in sclerotherapy alone group. Rebleeding after the first 48 hours was less in the octreotide treated patients 2/46 vs. 8/41 patients (p = 0.003). The octreotide treated patients had a better short term (5 days) survival without rebleeding 44/51 vs. 33/54 (p = 0.003) and shorter hospital stay, 5.31 +/- 3.87 days vs. 6.63 +/- 3.86 (p = 0.008) as compared to sclerotherapy alone group. The blood transfusion requirement was also less in the combined treatment group 3.88 +/- 2.80 vs. 5.37 +/- 3.15 units (p = 0.002).CONCLUSION: 1) The combination of sclerotherapy, and octreotide infusion over 48 hours is more effective than sclerotherapy alone in the treatment of acute variceal bleeding and prevention of early rebleed in cirrhotic patients. 2) It leads to shorter hospital stay and 3) less blood transfusion requirements. 4) Although early survival without rebleeding is improved, the overall mortality at the end of hospitalization period is similar in the two groups of treated patients

Superabsorbent Hydrogels for Heavy Metal Removal

The superabsorbent hydrogels (SAHs) are 3D polymer networks having hydrophilic nature, which can swell, absorb, and hold incredible amount of water in aqueous medium showing better sorption ability. The sorption ability enables SAH to absorb organic pollutants, dyes, and heavy metal ions (HMI) from wastewater. Therefore, SAHs have recently got considerable interest from the researchers to be used for wastewater treatment. In order to know the swelling property and to understand the wastewater treatment in general and heavy metal ion removal from industrial effluent in particular, this chapter describes the removal of heavy metal ions from wastewater in details. Thus this chapter will enable us to understand the theoretical and experimental part regarding the removal of heavy metal ions by SAH from wastewater. It also highlights the parameters of adsorption process such as effect of initial concentration of heavy metal ions, effect of external stimuli (pH), effect of temperature on the removal of heavy metal ions, and dosage studies. The synthesis of SAH and its use for removal of heavy metal ions from wastewater as well as recycling, selectivity, and effectiveness are also discussed in detail