Cognitive disposition to respond in postgraduate trainees of general surgery at Rawalpindi Medical University

Introduction: Cognitive biases leading to diagnostic errors are associate with adverse outcomes and compromise patient safety and contribute to morbidity and mortality. Exploration and identification of cognitive biases have been a difficult task for the clinicians and medical educators. The literature is deficient in the identification of cognitive biases in surgical trainees. The objective of the study was to identify various cognitive biases that may negatively impact clinical reasoning skills and lead to diagnostic errors in trainees of general surgery. Materials and Methods: A quantitative study was conducted involving 48 trainees of general surgery to explore the various cognitive biases. The questionnaire was devised and consisted of ten items devised to explore five biases. .Descriptive statistical analysis was done on SPSS 20 and the respondents with score >25 were categorized as predisposed to error scores of 20-25 were taken as a borderline and overall score of <25 was insignificant for the presence of cognitive bias. Results: Premature closure was the most frequent cognitive bias found significant in 34 (70 %) of trainees followed by anchoring bias in 14 (58, 3 %) trainees. The relative frequencies of different biases are shown in Table 2. The mean score of the questionnaire was 22.7 (range 10 to 38) SD 7.2. Ten out of forty-eight (21%) trainees with a mean score of >25 showed a clear inclination toward cognitive errors whereas 11 (22%) with a score in the range of 21 to 25 were categorized as having an equivocal tendency towards committing an error, Whereas 27 (56%) with a score of less than 20 were less prone to cognitive errors. Conclusion: The two most common errors seen in the study were anchoring bias and premature closure and both are related to information gathering. A larger study is required to explore the association of cognitive bias with different specialties and experience of clinicians

Analysis of Sectoral Energy Demand in Pakistan

Purpose This research aims to estimate the energy demand for different sectors, including commercial, industrial, residential, transportation, and agriculture. For this purpose, various factors affecting the demand for energy in each sector have been analyzed. Methodology The adopted methodology is box Jenkins a systematic approach of identification, estimation, diagnostic checks, and forecasting of the model. This model is appropriate for time series data of medium to long-term length. Findings The data analysis outcomes specified that Pakistan's energy demand mainly depends on five fuel types. Within each sector, the consumption of fuel varies. Results show that 86% of energy consumption share is held by transport oil, industrial gas, industrial coal, residential gas, and residential electricity. Conclusion The major issue in the energy sector is the demand-supply gap primarily caused by the gas and electricity deficit. Conclusively, sectoral demand increases in each sector where commercial, residential, and industrial energy demand has higher growth. Moreover, the price effect is negative for all variables except coal, making it a Giffen goo

Size selectivity in antibiofilm activity of 3-(Diphenylphosphino)propanoic acid coated gold nanomaterials against Gram positive Staphylococcus aureus and Streptococcus mutans

Abstract Biofilm formation by pathogenic bacteria is one of the major threats in hospital related infections, hence inhibiting and eradicating biofilms has become a primary target for developing new anti-infection approaches. The present study was aimed to develop novel antibiofilm agents against two Gram-positive bacteria; Staphylococcus aureus (ATCC 43300) and Streptococcus mutans (ATCC 25175) using gold nanomaterials conjugated with 3-(diphenylphosphino)propionic acid (Au-LPa). Gold nanomaterials with different sizes as 2–3 nm small and 9–90 nm (50 nm average size) large were stabilized by LPa via different chemical synthetic strategies. The nanomaterials were fully characterized using atomic force microscope (AFM), transmission electron microscope, ultraviolet–visible absorption spectroscopy, and Fourier transformation infrared spectroscopy. Antibiofilm activity of Au-LPa nanomaterials was tested using LPa alone, Au-LPa and unprotected gold nanomaterials against the both biofilm-producing bacteria. The results showed that LPa alone did not inhibit biofilm formation to a significant extent below 0.025 mM, while conjugation with gold nanomaterials displayed manifold enhanced antibiofilm potential against both strains. Moreover, it was also observed that the antibiofilm potency of the Au-LPa nanomaterials varies with size variations of nanomaterials. AFM analysis of biofilms further complemented the assay results and provided morphological aspects of the antibiofilm action of Au-LPa nanomaterials

Revisit a realistic intersecting D6-brane with modified soft SUSY terms

Because there are a few typos in the supersymmetry breaking sfermion masses and trilinear soft term, regarding the current Large Hadron Collider (LHC) and dark matter searches, we revisit a three-family Pati-Salam model based on intersecting D6-branes in Type IIA string theory on a $\mathbf{T^6/(\Z_2\times \Z_2)}$ orientifold with a realistic phenomenology. We study the viable parameter space and discuss the spectrum consistent with the current LHC Supersymmetry searches along with the dark matter relic density bounds from the Planck 2018 data. For the gluinos and first two generations of sfermions, we observe that the gluino mass is in the range [2, 14] TeV, the squarks mass range is [2, 13] TeV and the sleptons mass is in the range [1, 5] TeV. We achieve the cold dark matter relic density consistent with 5$\sigma$ Planck 2018 bounds via A-funnel and coannihilation channels such as stop-neutralino, stau-neutralino, and chargino-neutralino. Except for a few chargino-neutralino coannihilation solutions, these solutions also satisfy current nucleon-neutralino spin-independent and spin-dependent scattering cross-sections and may be probed by future dark matter searches.Comment: 18 pages, 6 figure

Primary non-functioning paraganglioma of liver: A rare tumour at an unusual location

Pheochromocytomas are rare tumours, 22% of which are extra-adrenal and are known as paragangliomas. We report a case of a young male with non-functioning paraganglioma of the liver; a very uncommon primary site. A CT scan with contrast showed a huge, highly vascular mass lesion in the right lobe of the liver and a core biopsy confirmed it to be a paraganglioma. Whole body study with iodine-131-meta-iodobenzylguanidine (MIBG) tracer highlighted the liver tumour but was negative for any other active lesions depicting that the tumour was confined to the liver. The lesion was completely resected by extended right hepatectomy and the patient had an uneventful recovery. There is no evidence of disease recurrence at 3 years of follow up

Evaluation of microleakage in single-rooted teeth obturated with thermoplasticized gutta-percha using various endodontic sealers: An in-vitro study

OBJECTIVE: To compare apical microleakage of extracted, single-rooted teeth obturated with thermoplasticized injectable gutta-percha using two different endodontic sealers (calcium-hydroxide and resin based). STUDY DESIGN: An experimental study. PLACE AND DURATION OF STUDY: The Aga Khan University Hospital (AKUH), Dental Clinics and Laboratory from June to September 2015. METHODOLOGY: The study was conducted using extracted teeth. After access cavities were made, cleaning and shaping of root canals was done in 70 teeth. Teeth were randomly allocated into two groups and obturated with thermoplasticized injectable gutta-percha (Obtura II) using two sealers (Sealapex vs. AH plus). After immersing the teeth in 2.0% methylene blue, they were split longitudinally, viewed under light microscope (magnification X4) and images were taken by a camera connected to microscope. The extent of dye penetration was assessed from apex to its coronal part and recorded in millimeters. Independent sample t-test was used to compare microleakage in the two groups. Pearson correlation coefficient was used for inter-examiner reliability of dye penetration measurements. A p-value of \u3c0.05 was taken as statistically significant. RESULTS: Teeth obturated with Obtura II gutta-percha with AH plus sealer had a mean dye penetration of 1.20 ±0.79 mm. This was significantly better than Obtura II with Sealapex sealer (p=0.003). CONCLUSION: Obtura II-AH plus sealer was a better combination for obturation as it showed a lesser degree of microleakage. Obtura II with Sealapex group showed higher microleakage, so this combination should be avoided in single-rooted teet

Challenges in diagnosis of disease reported 100 years back: Cushing syndrome; recent advances

Treatment of Cushing syndrome depends on diagnosis of etiology responsible for hypercortisolism in the body, which sometimes presents with a challenge. Inferior petrosal sinus sampling for ACTH levels, followed by peripheral venous sampling is a proven tool to be a gold standard for differentiating between peripheral and central cause of ACTH dependent Cushing syndrome. This case report is of an elderly female who presented as an outpatient in the endocrinology clinic of Aga Khan university hospital on 22/6/2017 with clinical features of hypercortisolism. After workup she was found to have cushing syndrome secondary to ACTH secreting bronchial carcinoid tumou