Upper extremity deep venous thrombosis prevalence in the NHS Grampian Medical Ambulatory clinic : diagnostic, therapeutic, and prognostic considerations in oncology patients

Peer reviewedPublisher PD

Spinal cord injury without radiographic abnormality (SCIWORA) in adults: A report of two cases

Spinal cord injury without any radiographic abnormality (SCIWORA) is rare in adults. We describe here two case reports of adult patients, who presented to us with quadriplegia, following a road traffic accident. Plain radiography and computed tomography (CT) of cervical spine were normal. Hence the patients were diagnosed as cases of adult SCIWORA. However, subsequent magnetic resonance imaging (MRI) of the two patients revealed cervical cord injury in the form of cord contusion and disc protrusion, respectively. Patient with cord contusion was managed medically, whereas the patient with disc lesion was treated with discectomy. Patient treated with discectomy showed marked improvement. Therefore, patients having no osseous injury on X ray and CT scan should have an MRI study done to look for surgically correctable pathology. As in such rare patients of SCIOWRA an early diagnosis and timely intervention is crucial; with MRI playing a pivotal role

The Dynamic Relation between Technology Adoption, Technology Innovation, Human Capital and Economy: Comparison of Lower-Middle-Income Countries

The advent of technologies has stimulated the economic growth of western countries, however, some Asian and African countries are among the Lower Middle Income Countries due to lack of technology adoption and digitally skilled human capital. The use of technologies produces digital competent human capital stock that accelerates economic growth. The prime goal of this article is to explore dynamics of technology adoption, technology innovation, human capital and skill development for Lower Middle Income Countries region over the period 2000-2016 by Generalised Method of Moments and cross sectional dependence. New technology adoption, technology innovation and human capital & skill development indices are formulated. The empirical findings indicate that human capital development & skill and investment have positive linkage with Lower Middle Income Countries economic growth while technology adoption and innovation have different linkage across the Lower Middle Income Countries regions. The panel error correction method was applied to estimate short run dynamics and convergence rate. The fully modified ordinary least square was applied to authenticate whether the long run estimates are consistent and valid for policy implications. The findings propose policy implications for advance technology adoption and innovation with the focus on human capital development & skill and investment in Lower Middle Income Countries region

Knowledge, attitudes and practices towards COVID-19 among Pakistani residents: Information access and low literacy vulnerabilities

Background: Coronavirus disease (COVID-19) has accentuated the need for speedy access to information. Digital divide and socio-demographic disparity create an information hiatus and therefore unhealthy practices with regard to dealing with COVID-19, particularly in low- and middle-income countries.Aims: We assessed knowledge, attitudes, practices and their determinants regarding COVID-19 in Pakistan during March-April 2020.Methods: 905 adults ≥18 years (males and females) participated: 403 from a web-based survey; 365 from an urban survey; and 137 from a rural survey. Frequency of adequate knowledge, attitudes and practices for the three populations was determined based on available global guidelines. Multivariable logistic regression analysis determined factors of adequacy of knowledge, attitudes, practices, and association of knowledge with attitudes and practices.Results: Mean age of the participants was 33.5 (+ SD 11.1) years, 51% were females. More females and young adults (18-30 years) participated in the web-based survey. The urban survey and web-based survey participants had significantly higher adequate knowledge (2-7 times) and practices (4-5 times) towards COVID-19. Adequate knowledge had a significant influence on healthy attitudes and practices for COVID-19, after adjustment for covariates. Overall, two-thirds of the population had high levels of fear about COVID-19, which was highest among the rural survey population.Conclusion: Substantial gaps exist in adequate knowledge, attitudes and practices, particularly among rural populations, and underscores the variation in access to information according to level of education and access to the internet. Thus, a comprehensive, contextually congruent awareness raising strategy is urgently needed to confront COVID-19 among these populations

A novel missense mutation in TNNI3K causes recessively inherited cardiac conduction disease in a consanguineous Pakistani family

Cardiac conduction disease (CCD), which causes altered electrical impulse propagation in the heart, is a life-threatening condition with high morbidity and mortality. It exhibits genetic and clinical heterogeneity with diverse pathomechanisms, but in most cases, it disrupts the synchronous activity of impulse-generating nodes and impulse-conduction underlying the normal heartbeat. In this study, we investigated a consanguineous Pakistani family comprised of four patients with CCD. We applied whole exome sequencing (WES) and co-segregation analysis, which identified a novel homozygous missense mutation (c.1531T\u3eC;(p.Ser511Pro)) in the highly conserved kinase domain of the cardiac troponin I-interacting kinase (TNNI3K) encoding gene. The behaviors of mutant and native TNNI3K were compared by performing all-atom long-term molecular dynamics simulations, which revealed changes at the protein surface and in the hydrogen bond network. Furthermore, intra and intermolecular interaction analyses revealed that p.Ser511Pro causes structural variation in the ATP-binding pocket and the homodimer interface. These findings suggest p.Ser511Pro to be a pathogenic variant. Our study provides insights into how the variant perturbs the TNNI3K structure-function relationship, leading to a disease state. This is the first report of a recessive mutation in TNNI3K and the first mutation in this gene identified in the Pakistani population

Are women with disabilities less likely to utilize essential maternal and reproductive health services?-A secondary analysis of Pakistan Demographic Health Survey

Background: People with disabilities deal with widespread exclusion from healthcare services, including sexual and reproductive health (SRH) rights. Studies analyzing the relationship between disability and key SRH utilization outcomes have often reported mixed findings. In Pakistan, very little to no literature is available on this topic, therefore we aim to determine inequalities in the utilization of essential maternal and reproductive health services between women with and without disabilities in Pakistan.Methods: This was a secondary analysis of Pakistan Demographic Health Survey 2017-18 performed on a weighted sample of 6,711 women aged 15-49 years with a live birth in the 5 years preceding the survey. Six types of disabilities were assessed i.e. vision, hearing, communication, cognition, walking and self-care. Utilization of essential maternal and reproductive health services was assessed through a set of four outcome variables: (i) modern contraceptive use; (ii) skilled antenatal care (ANC); (iii) skilled birth attendance (SBA); and (iv) skilled postnatal care (PNC). Multivariate Cox regression analysis was performed to determine the association between dependent and independent variables. Data were analyzed using Stata MP Version 16.0.Results: A total of 6,711 women were included out of which 14.1% (n = 947) live with at least one form of disability. Mean age was 29.4 (S.E = 0.13) years. The most prevalent form of disability was vision (7.0%), followed by walking (4.8%), cognition (4.8%) and hearing (1.8%). Women with disabilities were comparatively less educated, belonged to older age group, and had higher parity than their non-disabled counterparts. With the exception of modern contraceptive use, which was more prevalent in the group with disabilities, women with disabilities were less likely to utilize skilled ANC, SBA and PNC in bivariate analysis. However, these associations turned insignificant in the adjusted model. Overall, no statistically significant differences were observed in the utilization of essential reproductive health services between women with and without disabilities after adjusting for important covariates.Conclusion: Our analyses did not find any statistically significant differences in the utilization of essential maternal and reproductive health services between women with and without disabilities. In-depth research utilizing qualitative or mixed methods is required to understand how well the healthcare system in Pakistan is responsive to the different needs of disabled women

Optimization in supply chain management, the current state and future directions: a systematic review and bibliometric analysis

Purpose: The purpose of this paper is finding the current state of research and identifies high-potential area for future investigation in optimization in supply chain management. Design/methodology/approach: In this paper we present Bibliometric and Network analysis to examine current state research on optimization in supply chain management to identify established and emergent research field for future investigation. The systematic research review which we used in our study have not grasp or assess by other researchers on this topic. Firstly, based on our methodology Bibliometric analysis began by identifying 1610 publications raised from scientific journals, included literatures from 1994 to March of 2016. Secondly, we applied PageRank algorithm in our data for citation analysis to indicate the significance of a publication. Thirdly, the topological decision variables analysis is done based on Louvain method for network data clustering, for this proposes we used the rigorous tools. Finding: Based on our Network analysis result, the optimization in supply chain management research can be divided into four clusters/modules that introduced fundamental skill, knowledge, theory, application and method. Research limitations/implications: We presented some limitation in our research in some fields which could allow new researchers and practitioners conduct the future research to grow up in different dimensions. Practical implications: Practitioners or policy maker usually are not familiar with these type researches so this is why mush of these survey remain in theatrical and conceptual. Future investigation needs to play in practical application domain instead stop merely in opinion. Originality/value: Based on our research, the researchers have more attention to work in conceptual analysis due to other fields but we believe that in facility location problem there many remarkable rooms still exist for future research to development. We also contributed more details in the papers.Peer Reviewe

Impact of haemodialysis on plasma carnitine concentrations in haemodialysis patients

Objective: To evaluate the impact of haemodialysis on plasma carnitine levels. Method: The cross-sectional study was conducted from April 20, 2020 to May 10, 2022, at the dialysis unit of the nephrology ward of Jinnah Postgraduate Medical Centre, Karachi, and the Pakistan Navy Ship Shifa Hospital, Karachi, in collaboration with the Department of Biochemistry, University of Karachi, and comprised patients of either gender aged >18 years. They were divided into chronic kidney disease group A and end-stage renal disease group B. Control group C included subjects from the general population. Free carnitine and total carnitine values were detected using enzyme-linked immunosorbent assay. Acyl carnitine was estimated by applying the standard formula, and the ratio between acyl carnitine and free carnitine was calculated for accurate assessment of the carnitine status. Data was analysed using SPSS 23. Results: Of the 203 subjects, 143(70.44%) were cases and 60(29.55%) were controls. Among the cases, 120(84%) were recruited from Jinnah Postgraduate Medical Centre and 23(16%) from Pakistan Navy Ship Shifa Hospital. There were 60(29.55%) patients in group A, 83(40.88%) in group B and 60(29.55%) in group C. The mean age in group A was 47.90/5,65 years, it was 44.10/8.92 years in group B and 40.90/6.73 years in group C. There was a significant difference related to free carnitine, total carnitine, acyl carnitine values and the ratio between acyl carnitine and free carnitine values in groups A and B compared to control group C (p<0.05). Conclusions: Patients on maintenance haemodialysis developed were found to have developed carnitine deficiency. Key Words: Carnitine, Chronic kidney disease, Dialysis-related carnitine disorder, Haemodialysis