Prevalence of stress and depression among University students of Karachi

Stress is an all-time concerned issue in undergraduate students. Stress levels are high due to workload, pressure of academic and extra-curricular activities and unhealthy lifestyle. Though stress can be beneficial for academic growth but increased magnitude can be harmful for physiological, psychological and social aspects

Examining clinical indications for cesarean section in a university hospital in Karachi, Pakistan

Background and objectives: Current research reports that Pakistan exceeds the recommended percent of deliveries via cesarean sections, including both emergent and non-emergent. In order to better understand the high rate of cesarean sections in Pakistan we examined the medical and non-medical indications of these surgeries at a private university hospital in Karachi. Methods: A retrospective analysis of patient medical record data was conducted from January 1st, 2018 to March 31st, 2018. The data collected was analyzed using SPSS 25. Results: The total number of deliveries during the period was n= 1,211, out of which n=602 (49.70%) were CS. The top five indications for CS were: repeat CS n=199 (44.20%), failure to progress n=58 (12.90%), abnormal lie n=42 (9.30%), fetal distress n=37 (8.20%), and fetal growth restriction n= 21 (4.70%). Conclusion: This study contributes to a broader understanding of the indications of cesarean section rates in the developing world. This information can be used to improve infant and maternal health by reducing the complications associated with operative deliveries

Closed Loop Supply Chain: Evaluating Ecological Footprint

Purpose:  The purpose of this research is to evaluate the success of the closed-loop E-waste supply chain operations, primarily focused on achieving sustainability objectives related to the manufacturing, distribution, reusing, and discarding of electrical components. Methodology: The supply chain operations reference model offers suggestions and benchmarking tools to monitor the performance of supply chains and enhance the processes. This study illustrates a conceptual framework to show how these standards could be used in the E-waste supply chain to link business processes, metrics, industry standards, and technology to enhance the relationship and coordination between the supply chain members and to increase sustainability throughout the supply chain. Findings: According to an assessment of the literature, insufficient attention has been paid to the SCOR model's sustainability criteria. Consequently, in the wake of portraying the structure of the Supply Chain Operation Reference model, we make sense of which credits should be included in the Supply Chain Operation Reference to reflect manageability and which cycles and practices are related to every standard or should be remembered for Supply Chain Operation Reference to lay out the connection between execution, cycles, and practices. Conclusions: When a company's supply chain has achieved a desirable degree of eco-friendliness in all regards, its performance will be improved and satisfactory from a sustainability perspectiv

Corporate Social Responsibility through Collaboration in the Supply Chain: Insights into a More Sustainable Economy

Purpose The purpose of this study is to explore and analyze corporate social responsibility (CSR) as a helpful tool in solving significant societal concerns in countries where there is a greater desire for social and economic growth, such as Pakistan. Methodology In order to examine the current issues on supply chain collaboration for sustainability, this paper used a triangulation research method. In order to determine indicators in a CSR-intensive environment, data, and literature, the energy sector publications on EUR-Lex, international and European official papers, and the online site of the European Commission data sources were analyzed in this study. The indicators were divided into groups based on their sources (sets of standards and guidelines, council frameworks, document series, tools, and comprehensive legislation), as well as their intended uses (financial, social, and environmental). Findings The findings state that supply chain collaboration completely fulfills CSR for a viable economy. It focuses on three leading fashion brands and assesses their impact using open-source data, past research, and their official websites. It also highlights how, in comparison to global corporations, Pakistani business satisfies their corporate social responsibility.  Conclusion It is concluded that a supply chain can help companies minimize the environmental impact of their supply chain processes. Further, CSR is a part of the supply chain that helps businesses determine their social and economic responsibilities by focusing on environmental aspects to add to a more sustainable economy

Global Retinoblastoma Presentation and Analysis by National Income Level.

Importance: Early diagnosis of retinoblastoma, the most common intraocular cancer, can save both a child's life and vision. However, anecdotal evidence suggests that many children across the world are diagnosed late. To our knowledge, the clinical presentation of retinoblastoma has never been assessed on a global scale. Objectives: To report the retinoblastoma stage at diagnosis in patients across the world during a single year, to investigate associations between clinical variables and national income level, and to investigate risk factors for advanced disease at diagnosis. Design, Setting, and Participants: A total of 278 retinoblastoma treatment centers were recruited from June 2017 through December 2018 to participate in a cross-sectional analysis of treatment-naive patients with retinoblastoma who were diagnosed in 2017. Main Outcomes and Measures: Age at presentation, proportion of familial history of retinoblastoma, and tumor stage and metastasis. Results: The cohort included 4351 new patients from 153 countries; the median age at diagnosis was 30.5 (interquartile range, 18.3-45.9) months, and 1976 patients (45.4%) were female. Most patients (n = 3685 [84.7%]) were from low- and middle-income countries (LMICs). Globally, the most common indication for referral was leukocoria (n = 2638 [62.8%]), followed by strabismus (n = 429 [10.2%]) and proptosis (n = 309 [7.4%]). Patients from high-income countries (HICs) were diagnosed at a median age of 14.1 months, with 656 of 666 (98.5%) patients having intraocular retinoblastoma and 2 (0.3%) having metastasis. Patients from low-income countries were diagnosed at a median age of 30.5 months, with 256 of 521 (49.1%) having extraocular retinoblastoma and 94 of 498 (18.9%) having metastasis. Lower national income level was associated with older presentation age, higher proportion of locally advanced disease and distant metastasis, and smaller proportion of familial history of retinoblastoma. Advanced disease at diagnosis was more common in LMICs even after adjusting for age (odds ratio for low-income countries vs upper-middle-income countries and HICs, 17.92 [95% CI, 12.94-24.80], and for lower-middle-income countries vs upper-middle-income countries and HICs, 5.74 [95% CI, 4.30-7.68]). Conclusions and Relevance: This study is estimated to have included more than half of all new retinoblastoma cases worldwide in 2017. Children from LMICs, where the main global retinoblastoma burden lies, presented at an older age with more advanced disease and demonstrated a smaller proportion of familial history of retinoblastoma, likely because many do not reach a childbearing age. Given that retinoblastoma is curable, these data are concerning and mandate intervention at national and international levels. Further studies are needed to investigate factors, other than age at presentation, that may be associated with advanced disease in LMICs

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

The global retinoblastoma outcome study : a prospective, cluster-based analysis of 4064 patients from 149 countries

DATA SHARING : The study data will become available online once all analyses are complete.BACKGROUND : Retinoblastoma is the most common intraocular cancer worldwide. There is some evidence to suggest that major differences exist in treatment outcomes for children with retinoblastoma from different regions, but these differences have not been assessed on a global scale. We aimed to report 3-year outcomes for children with retinoblastoma globally and to investigate factors associated with survival. METHODS : We did a prospective cluster-based analysis of treatment-naive patients with retinoblastoma who were diagnosed between Jan 1, 2017, and Dec 31, 2017, then treated and followed up for 3 years. Patients were recruited from 260 specialised treatment centres worldwide. Data were obtained from participating centres on primary and additional treatments, duration of follow-up, metastasis, eye globe salvage, and survival outcome. We analysed time to death and time to enucleation with Cox regression models. FINDINGS : The cohort included 4064 children from 149 countries. The median age at diagnosis was 23·2 months (IQR 11·0–36·5). Extraocular tumour spread (cT4 of the cTNMH classification) at diagnosis was reported in five (0·8%) of 636 children from high-income countries, 55 (5·4%) of 1027 children from upper-middle-income countries, 342 (19·7%) of 1738 children from lower-middle-income countries, and 196 (42·9%) of 457 children from low-income countries. Enucleation surgery was available for all children and intravenous chemotherapy was available for 4014 (98·8%) of 4064 children. The 3-year survival rate was 99·5% (95% CI 98·8–100·0) for children from high-income countries, 91·2% (89·5–93·0) for children from upper-middle-income countries, 80·3% (78·3–82·3) for children from lower-middle-income countries, and 57·3% (52·1-63·0) for children from low-income countries. On analysis, independent factors for worse survival were residence in low-income countries compared to high-income countries (hazard ratio 16·67; 95% CI 4·76–50·00), cT4 advanced tumour compared to cT1 (8·98; 4·44–18·18), and older age at diagnosis in children up to 3 years (1·38 per year; 1·23–1·56). For children aged 3–7 years, the mortality risk decreased slightly (p=0·0104 for the change in slope). INTERPRETATION : This study, estimated to include approximately half of all new retinoblastoma cases worldwide in 2017, shows profound inequity in survival of children depending on the national income level of their country of residence. In high-income countries, death from retinoblastoma is rare, whereas in low-income countries estimated 3-year survival is just over 50%. Although essential treatments are available in nearly all countries, early diagnosis and treatment in low-income countries are key to improving survival outcomes.The Queen Elizabeth Diamond Jubilee Trust and the Wellcome Trust.https://www.thelancet.com/journals/langlo/homeam2023Paediatrics and Child Healt

Outcome and Prognostic Factors Seen in Pediatric Oncology Patients Admitted in PICU of a Developing Country

To evaluate the outcome and prognostic factors for oncology Patients in the PICU of a tertiary care centre in a developing country.A retrospective chart review was done to assess the outcome of children with cancer in the pediatric intensive care unit (PICU) of a developing country from January 2000 through December 2009. 74 medical records were reviewed for data regarding demographics, admitting diagnosis, Pediatric Risk of Mortality (PRISM) III score and the therapeutic modalities used.Of the 74 children admitted with mean age of 6.3 years (range 1-14), 53 were boys (71.6%) and 21 were girls (28.4%). Majority of the Patients (37%) had hematological malignancy. The major indication for PICU admission was post-operative care (32%) followed by acute respiratory failure (24.3%), neurological complications (20.3%). The median PRISM III score was 7.0 (range 0-30). The overall mortality was 32.4% (24/74). The mean length of PICU stay was 6.3 days (ranging from 0-28 days). Seventy percent (52/74) of the children had multi organ failure (MOF). Mortality was significantly related to presence of multi-organ dysfunction syndrome and high PRISM III scores on admission and use of inotropic support with mechanical ventilation.The mortality in children with cancer in PICU in the present study is comparable to previous reports and is related to higher PRISM III score, presence of multiorgan dysfunction syndrome and use of ICU therapies

Implant biomechanics relating to the dental implant and prosthesis design: In-vitro strain gauge analysis and finite element analysis

Background: Biomechanics of an implant-supported prosthesis play a key role in the success or failure of rehabilitation of missing teeth. This study aimed to analyze biomechanical factors, such as an implant design and prosthesis design for a single implant-supported prosthesis. An in-vitro strain gauge analysis and finite element analysis were performed to assess different implant thread shapes and prosthesis retention modes for their strain-producing property in the peri-implant region of bone. Methodology: Four study models were prepared. Two models were fitted with Bio Horizon Tapered-Pro implants having predominant buttress-shaped threads (BT) and then two models were fitted with Grande Morse Neo Dent implants having trapezoid-shaped threads (TT). Each design was used with two types of retention modes for prostheses, BP-C and TT-C for cement-retained prostheses and similarly BT-S and TT-S for screw-retained prostheses. The strain gauges were bonded to the models and connected to a strain meter. Using an opposing porcelain fused to a metal prosthesis, a combined (axial and non-axial) load of 50–300 N at a strain rate of 0.95 mm/s was applied stepwise to each prosthesis. The strain values were recorded, and the collected data were organized and analyzed using SPSS version 22. For the finite element analysis, four 3-D models were designed. The bone, dental implants, and prostheses for each group were designed using Solid Works. A static, linear simulation was conducted in Ansys software. Results and discussion: The strain values recorded were all less than 3000μɛ and within the physiological loading zone as per Frost’s theory. Statistically significant differences were found between all groups with p-values <0.05, suggesting that changes in implant design led to differences in peri-implant bone strains. At the maximum loading of 300 N, i.e., at the mean biting force of an individual adult, the maximum strain value of 1812 με was recorded for group TT-C. At the minimum loading, all strain values were less than 500 με except for group TT-C for which 518 με was recorded. The peri-implant bone next to the implant’s crest showed maximum strain, which means that this site is more subjected to the effects of overloading than any other part. The von Mises stress was seen concentrated at the implant neck. Conclusion: TT-C implant-supported prostheses give a high strain profile. In comparison, the BT-C implant-supported prostheses give a low strain profile at mean biting forces