Awareness to Handle Research and Healthcare Waste (RHCW) in teaching and research institutes; a comprehensive review

Environmental pollution has become the major challenge not only for developing countries but also for developed ones Worldwide. The major goal of this comprehensive review is to compile the reference data regarding the different types of waste generated in teaching, research, and healthcare institutes and specific strategy to manage such wastes. In addition to the pharmaceutical, leather, chemicals, food, and paper industries, teaching, research, and healthcare institutions are also significant sources of different types of Non-hazardous as well as hazardous wastes. Therefore, a simple and implementable guideline for cleaning and waste disposal services in such institutions requires strict adherence to applicable policies and procedures. Research and healthcare waste (RHCW) management is a joint effort among Research Laboratory Personnel, Healthcare facilitators, Building Services Personnel, and Local Environmental Health and Safety Personnel. As Pakistan is among the developing countries situated in South Asia, most of the institutes, including teaching, research, and healthcare, try to follow the WHO guidance or manage hazardous and non-hazardous wastes with self-planned strategies. Although most of the local Governing bodies and Institutional bodies are trying to handle the wastes at their levels by following different protocols, introducing a protocol at the National level is the need of the current era to fight against environmental pollutants.

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

Perceptions and Practices of Herbal Remedy Usage during the COVID-19 Pandemic: A Call for Evidence-Based Healthcare in Pakistan

Objective: To determine the prevalence, perception and practices towards the use of herbal remedies by Pakistani population during the era of covid 19 pandemic. Methodology: This cross-sectional explorative study was conducted at Department of medicine Sir Syed Medical College Karachi 2021 from the month of August 2021 to December 2021. An online google form well written by primary investigator was distributed generally to various what’s up forum throughout Pakistan with no specific inclusion or exclusion criteria. First section of the questionnaire included demographics of participants, second section include about the use of herbal remedy types, perception, beliefs of their use, source of getting them and the remedies used for the prevention of covid virus  Results: This study, was conducted from August to December 2021 spread through google online forms, included 332 respondents, 52.1% of participants utilized herbal remedies for COVID-19 prevention, with 55.5% belonging to the 25-45 age group with 81.3% of them were educated females. A significant association (p<0.05) was observed between herbal remedy usage and age group, gender, education, and occupation. Senna Makki (38.8%), ginger (17.7%), and kalonji (10.2%) were commonly used herbs. While 37.7% reported health benefits, 15.1% believed these herbs had no side effects, and 22.3% used them for virus prevention. Attitudes toward herbal remedy usage revealed that 47.4% agreed these herbs could prevent disease, and 36% believed no additional preventive measures were necessary while using them. Family tradition (19.3%), health professionals (14.5%), and internet/media (14.2%) were key sources of information, while Hakeem stores (16.6%) and family members (7.8%) were common herbal remedy providers. Conclusion: This study highlights an urgent need for evidence-based healthcare interventions in Pakistan regarding the utilization of herbal remedies during the virus pandemic especially when there are risks associated with the improper use and potential influence from media. Key words: Covid 19 pandemic, Herbal remedies, Perception, Practice

Impact of Food Literacy on Consumer's Food Purchasing Habits and Dietary Intake - A Systematic Review

Introduction: A well-nourished population represents the sustainable development of a nation. Poor alignment between food intake and dietary recommendations results in consumption of high calorie, low nutrient dense foods. Aims & Objectives: The main goal of this study is to find the relation between food literacy and dietary intake. Secondly, to assess the influence of food literacy on food purchasing habits. Place and duration of study: For this review, collection of studies from PubMed and Cochrane databases was started in May 2020 and was finalized by June 2020. Material & Methods: The eligibility criteria were based on two factors; that the study be written in English and published through a peer reviewed journal. Through the database search, total 673 studies were identified. After checking studies thoroughly at various steps, only 26 were included in this review. Results: 11 studies claimed the link between food label reading and intake of nutrients, while there were 10 studies that measured the consumer's purchase and food choices by their awareness level about food labels. Conclusion: This systematic review demonstrates nutrition education to be directly correlated with the food-related habits of people. Further research is required to get a clear vision about knowledge of nutritional labels and its effect on real life dietary choices

Cohort profile: the ESC EURObservational Research Programme Non-ST-segment elevation myocardial infraction (NSTEMI) Registry

Aims The European Society of Cardiology (ESC) EURObservational Research Programme (EORP) Non-ST-segment elevation myocardial infarction (NSTEMI) Registry aims to identify international patterns in NSTEMI management in clinical practice and outcomes against the 2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without ST-segment-elevation. Methods and results Consecutively hospitalised adult NSTEMI patients (n = 3620) were enrolled between 11 March 2019 and 6 March 2021, and individual patient data prospectively collected at 287 centres in 59 participating countries during a two-week enrolment period per centre. The registry collected data relating to baseline characteristics, major outcomes (inhospital death, acute heart failure, cardiogenic shock, bleeding, stroke/transient ischaemic attack, and 30-day mortality) and guideline-recommended NSTEMI care interventions: electrocardiogram pre- or in-hospital, prehospitalization receipt of aspirin, echocardiography, coronary angiography, referral to cardiac rehabilitation, smoking cessation advice, dietary advice, and prescription on discharge of aspirin, P2Y12 inhibition, angiotensin converting enzyme inhibitor (ACEi)/angiotensin receptor blocker (ARB), beta-blocker, and statin. Conclusion The EORP NSTEMI Registry is an international, prospective registry of care and outcomes of patients treated for NSTEMI, which will provide unique insights into the contemporary management of hospitalised NSTEMI patients, compliance with ESC 2015 NSTEMI Guidelines, and identify potential barriers to optimal management of this common clinical presentation associated with significant morbidity and mortality