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Objectives: We planned this study to find out morbidity patterns as well as outcome of admitted children aged less than 5 years of age with severe acute malnutrition (SAM). Study Design: Cross Sectional study. Setting: Department of Pediatrics Medicine, Ghurki Trust Teaching Hospital, Lahore. Period: From 1st January 2018 to 30th June 2018. Material & Methods: A total of 80 children aged 1 to 59 months, of both genders, having SAM were considered. Physical examination, detailed clinical as well as laboratory findings related to nutritional status and comorbidities were noted. Outcome in terms of recovery/discharge, left against medical advice (LAMA) or death during the stay was noted in all the children. Results: Out of a total of 80 children, 20 (25.0%) were aged 1 to 6 months, 39 (48.8%) from 7 to 24 months and 21 (26.2%) from 25 to 59 months. Most of the patients, 39 (48.8%) were from 7 to 24 months of age, 62 (77.5%) were admitted through emergency, 52 (65.0%) had WHZ score-4SD and 27 (33.8%) using bottle feeding. Severe wasting without having edema was reported in 67 (83.8%) children. Diarrhea was the commonest comorbidity, found in 43 (53.8%) children, followed by sepsis 17 (21.3%) and pneumonia 15 (18.8%). There were 69 (86.3%) children noted having anemia. Hyponatremia was the commonest metabolic abnormality seen in 40 (25.0%) children. In terms of outcome, 71 (88.7%) children recovered well and got discharged while mortality was reported in 5 (6.3%) children. Conclusion: Diarrhea along with sepsis and pneumonia along with metabolic abnormalities were found to be more prevalent amongst children having SAM. Early identification of anemia as well as infections in children with SAM can contribute to better outcome.

Objectives: To evaluate the role of RIPASA scoring system for diagnosis of acute appendicitis taking histopathology as gold standard. Study Design: Prospective Study. Setting: Department of General Surgery, Nishter Hospital Multan. Period: February 2016 to February 2017. Material & Methods: One hundred and sixty 160 patients were included in this study. Study was started after ethical approval from ethical board of institution and informed consent from patients was taken. Non probability consecutive sampling was used. Main outcome variables were sensitivity, specificity and diagnostic accuracy of RIPASA score. SPSS version was used to analyze data. P value ≤ 0.05 was considered as significant. Results: Estimated sensitivity was 97.9%, which means that of the patients with acute appendicitis, 97.9% were diagnosed correctly. The estimated specificity was 76.9%, which means that of the patients not having acute appendicitis, 76.9% were diagnosed correctly. Positive predictive value was 86.1% and negative predictive value was 96.2%. The overall accuracy was 89.4% for diagnosing acute appendicitis. Conclusion: RIPASA scoring system is efficient, reliable and more diagnostic in cases of acute appendicitis. Abdominal ultrasonography is not suitable diagnostic tool to rule out negative appendectomy.

Objectives: Community acquired pneumonia (CAP) is frequent amongst pediatric population all over the world while hyponatremia is a common electrolyte abnormality in hospitalized patients that has been shown to be associated with considerable morbidity and mortality. We aimed to determine the frequency of hyponatremia in children with community acquired pneumonia (CAP). Study Design: Cross Sectional study. Setting: Pediatrics Department, Services Hospital, Lahore. Period: July 2018 to January 2019. Material & Methods: A total of 100 cases up to 2 years of age of either gender, diagnosed cases of CAP during the last 72 hours, were enrolled. Demographic profile, age and gender were recorded. Every child with CAP was evaluated for the presence of hyponatremia. Mean and standard deviation were calculated for age. Frequency and percentages were noted for categorical variable like gender and presence/absence of hyponatremia. Results: Out of 100 cases of CAP, 57 (57.0%) were male and 43(43.0%) female. There were 45 (45.0%) cases who were less than 1 year of age while 55 (55.0%) were between 1-2 years of age. Mean age was calculated as 1.55 years with standard deviation of 0.52 years. Frequency of hyponatremia in children with CAP was recorded in 24 (24.0%) whereas 76 (76.0%) had no findings of the morbidity. Conclusion: Frequency of hyponatremia was high (24.0%) among children with CAP. Every patient who present with CAP should be evaluated for hyponatremia.

PurposeThis empirical study aims to explore the linkage among authentic leadership traits and job performance via the mediating role of high-performance human resource practices (HPHRPs) in a developing country context. Social exchange theory and trait theory are widely employed in many disciplines but seldom applied to job performance among Pakistan Telecommunication Company Limited (PTCL) employees.Design/methodology/approachThe sample of the study is PTCL's employees. A cross-sectional design was employed and data was collected from 377 employees via questionnaire. This is an exploratory study; therefore, partial least square–structural equation modeling (PLS-SEM) was employed to answer the research questions.FindingsThe findings of this study revealed that relational transparency, directly and indirectly, influenced job performance with the partial mediating role of selective staffing and extensive training. Furthermore, balance processing, directly and indirectly, influenced job performance with the partial mediating role of incentive reward, while self-awareness, internalized moral perspective, employment security and result-oriented appraisal were insignificant influences on job performance.Practical implicationsThe results of the study delineated practical applications for both the researchers and policymakers. The results of this study would also augment the body of knowledge on human resource practices in both developed and developing countries.Originality/valueThis study found and reported authentic leadership traits and HPHR as the main sources of job performance in PTCL. This study empirically examined the influence of authentic leadership traits on job performance with the mediating role of a bundle of HPHRPs in a developing context.

Objectives: Childhood and adolescent obesity is increasing especially in developing countries like Pakistan. It seem to affect most socio-economic classes as well as all ethnicities and geographies. We planned this study to analyze the clinical and biochemical profile of obese as well as overweight children at a tertiary care hospital for the existence of metabolic syndrome. Study Design: Cross sectional study. Setting: Department of Pediatrics Medicine, Children Hospital Chandka Medical College / Shaheed Mohtarma Benazir Bhutto Medical University, Larkana. Period: 1st July 2018 to 31st December 2018. Material & Methods: Children, aged 5 to 16 years, both gender, having BMI > 85th percentile regarding age and gender were enrolled. Demographic characteristics along with history, lifestyle parameters and physical examination were noted for all the study participants. Metabolic syndrome (Met S) was evaluated while overall results were presented in terms of proportions, mean and standard deviations. Results: A total of 78 cases were enrolled during the study period. There were 46 (58.9%) male and 32 (41.1%) female, with a male to female ratio of 1.4:1. Mean age amongst study participants was 10.8 years. We had 56 (71.8%) children as overweight whereas 22 (28.2%) obese. Acanthosis nigricans was the most common entity seen in 55 (70.1%) children during clinical examination. Metabolic syndrome was found to be present in 31 (39.7%) participants. Conclusion: Met S is not only limited to obese children as it can also affect children who are overweight.

Objectives: Febrile seizures (FS) are the most common type of seizures and typically transpire in children with ages from 6 to 60 months. This study was planned to find out major clinical risk factors for seizures in febrile children who were aged 6 to 60 months. A total of 100 febrile children aged 6 to 60. Study Design: Analytical Study. Setting: Department of Neurology, Children’s Hospital and the Institute of Child Health, Multan. Period: From 1st April 2018 to 31st December 2018. Material & Methods: Group A had 40 children with febrile seizures while group B had 60 febrile children but without seizures. Demographic features along with family history of (H/O) epilepsy as well as family history of febrile seizure, types of seizure and infection diseases were noted and analyzed using SPSS version 20. Odds ratio was calculated for various risk factors. Chi square test was applied and P value < 0.05 was considered as significant. Results: Out of a total of 100 children, there were 54 (54.0%) male and 46 (46.0%) female. There was no statistical difference in terms of gender between the two groups (p value = 0.566). Overall, mean age of the children was 26.02 months with standard deviation of 13.4 months. There were 28 (70.0%) children who reported with simple seizures while complex seizures were found in 12 (30.0%) cases. Statistically significant difference (p value = 0.001) was seen in terms of types of infections between the two study groups. When risk of seizures for various risk factors was calculated, family H/O FS, family H/O epilepsy, and upper RTI were as 14, 7 and 3 times respectively and turned out to be the major risk factors for seizures in febrile children. Conclusions: Family H/O FS, family H/O epilepsy and upper RTIs are the major risk factors related with seizures in febrile children. Measures to prevent these risk factors can decrease the burden of FS in our population.

Objectives: We planned this study to observe the pattern related to bacterial isolates causing neonatal septicemia along with their pattern of antibiotic susceptibility. Study Design: Prospective study. Setting: Department of Neonatology, Sheikh Khalifa Bin Zaid Al Nahyan Teaching Hospital, Rawlakot. Period: From 1st January 2018 to 30th June 2018. Material & Methods: Prior to empiric antibiotic usage, blood was collected from neonates having clinical sepsis and sent for blood culture. A total of 60 neonates with culture proven sepsis were enrolled for this study. Reports of blood culture were evaluated for isolates of bacteria as well as patterns of sensitivity for frequently used antibiotics in the institution. SPSS version 21.0 was used for data entry and analysis. Results: A total of 60 neonates having culture proven sepsis were enrolled in the current study. Amongst these, 39 (65.0) were male and 21 (35.0%) female. Early onset of sepsis was diagnosed in most, 42 (70.0%) neonates. Majority of neonates, 50 (83.3%) were delivered in the same hospital. Gram negative isolates were found in 43 (71.7%) and 15 (25.0%) gram positive while 2 (3.3%) candida spp. In terms of pattern of antibiotic sensitivity, 4 (9.3%) isolates of gram negative were found resistant to every antibiotic routinely used while gram positive isolates showed excellent sensitivity to vancomycin. Conclusion: Gram negative isolates of organisms were found to be the most sensitive to carbepenems (especially meropenem) as well as aminoglycosides while gram positive isolates showed excellent sensitive regarding vancomycin.

The current study is aimed to utilize the microwave for isolation of colorant from neem bark and its application onto chemical & bio-mordanted cotton fabric. For the purpose, aqueous, acid and organic media have been employed to isolate the colorant and to make its application onto surface modified and bio-mordanted cotton fabric followed by microwave treatment up to 6min. It is found that using optimum extraction and dyeing conditions, acceptable fastness properties have been rated when 9% of Al & Fe, 7% of tannic acid as pre chemical, 7% of acacia, 9% of henna, 7% of pomegranate & 5% of turmeric extract as pre bio mordants. Similarly, 5% of Al, 9% of T.A, 7% of pomegranate, and turmeric extract as post-mordants have been employed. It is recommended that isolation of colorant & dyeing under MW treatment has not only improved the natural dyeing process but also the addition of herbal-based bio-mordants have made the dyeing process more sustainable & ayurvedic. So it is concluded that microwave treatment has not only explored the coloring potential of neem bark but also made possible use of bio-mordants for making process more green with excellent color characteristics under reduced optimal conditions.

Study intent to identify the direct (indirect) risk factors that can influence the export of medical instruments from SMEs sector of Pakistan by using the time series monthly data sample for a period of fifteen years that is from FY 2003 to FY 2017. Empirically a strong long term relation between the export of medical instruments with operational risk, market risk, export refinance schemes and steel prices are proven by Johansen co-integration. Study also establishes a direct positive relation of operational risk and market risk with the export of medical instruments as a result of Vector Error Correction Model.

Objectives: LBW has long been labeled as one of the major risk factor for mortality as well as morbidity in neonates. South Asia is said to have highest number of LBWs which estimated to be 1 in 4 newborns that weigh < 2500 grams. This study was planned with an aim to note the burden, types of diseases and outcome in LBW newborns admitted at a tertiary care hospital. Study Design: Descriptive analytical study. Setting: Included all neonates admitted to NICU of Sheikh khalifa Bin Zaid Al Nahyan Teaching Hospital, Rawlakot. Period: 1st July 2018 to 31st December 2018. Material & Methods: The prevalence of LBW amongst all admissions was calculated along with demographic features of all LBW babies like disease, reasons for the admission, duration of hospital stay along with outcome was noted on a predesigned proforma. Results: Out of total of 1410 admission in NICU during the study period, 512 (36.3%) were noted to be LBW. Amongst LBW babies, mean weight was 1.91 kg while 269 (52.5%) were male and 243 (47.5%) female. There were 364 (67.6%) babies born at full term. There were 82 (16.0%) with birth weight of less than 1.5 kg, 166 (32.4%) between 1.5 to 2 kg while 264 (51.6%) were above 2 kg. Amongst all LBW babies, mortality was reported in 185 (36.1%) while 112 (60.5%) died on the 1st day of admission. Respiratory distress syndrome (31.4%), sepsis (20.3%) and neonatal jaundice 58 (11.3%) were the commonest diseases seen. Highest mortality (56.1%) was seen in babies who had birth weight below 1.5 kg (p value = 0.001). Conclusion: LBW is a major cause of hospitalization and mortality. RDS and sepsis were the most frequent diseases noted in LBW babies. Immediate care following birth is vital for babies already at risk of LBW.

A radio-resistant bacterium labeled as strain TMC-6 was isolated from Thal desert, Pakistan and identified through 16S rRNA gene sequencing as Bacillus indicus strain TMC-6 (MN721293). The isolate was found to be resistant to UV radiation dose of 6.780 × 103 J/m2 and showed 50% survivability to mitomycin C (6 μg/ml) and H2O2 (30 mM). The bacterium showed yellowish orange coloration when grown on tryptone yeast glucose (TGY) medium. The cellular metabolite was extracted in methanol and purified through solid phase extraction with C18 column cartridge. The compound was characterized through UV/Visible spectrophotometry, Fourier Transform Infra-Red (FT-IR) spectroscopy and Liquid Chromatography Mass Spectrometry (LC–MS). The LC–MS analysis of the compound revealed a molar mass of 769 [m/z]− that matched the chemical formula C34H42O20 and identified as a glycosylated flavonoid xanthorhamnin. The compound showed significant antioxidant (77.05%) and metal chelation (79.80%) activities. Xanthorhamnin showed promising oxidative damage inhibitory actions in bovine serum albumin (65.32%) and mice liver lipids (71.61%) and prevented DNA strand breaks from oxidative stress. Cytotoxicity in brine shrimp larvae was observed when compared with mitomycin C indicating its effect toward cancerous cells. These findings concluded that xanthorhamnin from radio-resistant Bacillus indicus strain TMC-6 has high antioxidant, radioprotective, and antitumor properties against UV-mediated oxidative damages.

Objectives: Neck pain is a frequent spinal pain problem and considered an important health issue in the modern world. Neck pain may originate from intervertebrals discs, ligaments, muscles or of the structures involving the neck. The aim of this study was to find out characteristics along with social and psychological implications of musculoskeletal neck pain amongst children aged 8 to 18 years. Study Design: Descriptive study. Setting: Orthopedic Department of Mayo Hospital, Lahore. Period: From March 2017 to February 2018. Material & Methods: A total of 260 children and adolescents of both genders, aged 8 to 18 years and having musculoskeletal neck pain with spasm were enrolled in this study. A structured questionnaire was interviewed from participants or parents/guardians of this study. Results: Out of a total of 260 cases, there were 125 (48.1%) were boys and 135 (51.9%) girls. Most cases, 158 (60.8%) were between the age of 12 to 18 years while mean age amongst study participants was 14.58+2.63 years. Most of the children, 98 (37.7%) were studying in high school. All 260 cases had flawed flexion of back and neck during study and while using mobile phones or similar devices. Pain location involving neck was recorded in all 260 (100%) study participants while shoulder pain was demonstrated by 188 (72.3%). Most common eye symptoms were eye strain, in 64 (24.6%). Most of the cases, 180 (69.2%) were having irritability while poor communication was noted in 164 (63.1%). Conclusion: Musculoskeletal neck pain is frequent amongst children and adolescents. Hunching the head, neck and shoulders on mobile phones and similar devices, as well as improper posture during studying and watching television increase stress on cervical spine area, may be leading to musculoskeletal neck pain.

Ferula narthex Boiss., Apiaceae, is commonly used in Pakistan and India as spice and it is associated with diverse biological activities including antidiabetic and anti-inflammatory. Research has suggested that the genus Ferula is rich in sesquiterpene coumarins. During this project, both in vitro and in silico models were adopted to investigate its traditional use. Based on structural diversity, selected compounds isolated from the exudate were processed for molecular docking studies. The negative binding energies and close proximity to residues in the binding pocket of selected targets including human α-glucosidase (PDB ID 3TOP) and soybean LOX (PDB ID 1IK3) were recorded, which indicated high affinity and tight binding capacity of 10′-R-acetyl-karatavacinol and 10′-R-karatavacinol towards the active sites of α-glucosidase and 15-lipoxygenase. 10′-R-acetyl-karatavacinol exhibited the highest inhibition of α-glucosidase in vitro (IC50 0.05 mM), whereas in the 15-lipoxygenase inhibition assay, 10′-R-karatavacinol was most active (70%, at 0.023 mM final concentration). It was therefore concluded that 10′-R-acetyl-karatavacinol had the highest α-glucosidase inhibitory activity, whereas 10′-R-karatavacinol was a 15-lipoxygenase inhibitor with potentially anti-inflammatory properties.

Objectives: Hypoglycemia is a matter of great concern especially in newborns. Its prevalence varies globally as different protocols and feeding policies exist. We aimed this study to find out the incidence of hypoglycemia in newborns with risk factors of hypoglycemia. Study Design: Observational study Setting: Pediatric Medicine Unit-2, Mayo Hospital, Lahore. Period: From 1st January 2018 to 31st December 2018. Material & Methods: A total of 342 babies born with risk factors for hypoglycemia fulfilling the inclusion and exclusion criteria were considered for this study. Screening for hypoglycemia was performed prior to feeding at 2, 6, 12, 24 and 48 hours of life. Results: Out of a total of 342 newborns with risk factors, 109 (31.9%) were found to have hypoglycemia. Amongst these newborns, 99 (28.9%) and 10 (2.9%) newborns had asymptomatic and symptomatic hypoglycemia respectively. Among these 109 newborns, majority were male 56 (51.4%), 70 (64.2%) with gestational age more than 37 weeks, 66 (60.6%) with birth weight more than 2500 grams and 62 (56.9%) small for gestational age (SGA). Amongst newborns who developed at least 1 hypoglycemia episode, 52 (47.7%) were at 2 hours of life, 31 (28.4%) at 6 hours whereas no hypoglycemia episode recorded beyond 24 hours of life. Conclusions: Screening for hypoglycemia should always be performed in babies who had risk factors of hypoglycemia especially within 24 hours of life. As per our study blood glucose screening should be mandatory in all newborns who are SGA.

This article presents a novel strategy regarding the stabilization control problem for plants with unmatched uncertainties. The methodology is based on Adaptive Smooth Super Twisting Sliding Mode Control. At first, as an initial step, the plant with unmatched uncertainty is transformed into a plant with matched uncertainty. At the second step, the plant with matched uncertainty is decomposed into a unique framework containing the nominal part and some unknown terms (where these unknown terms are computed adaptively). The nominal system is stabilized by using Smooth Super Twisting Sliding Mode Control. The stabilizing controller for the plant with matched uncertainty is designed in a way; it contains some nominal control plus some compensator term. The stability of the said technique is presented impressively. The compensator controller and the adapted laws are derived in such a way that the time derivative of a Lyapunov function becomes strictly negative. The proposed method is tested on a fourth-order plant. The simulation results show the effectiveness and validity of the proposed controller.

Objectives: Relationship amongst celiac disease (CD) and lung diseases has been discussed in the past. Studies have documented that CD is linked with lung diseases. CD has also been described to complement asthma. This study was planned to document the prevalence of asthma as well as allergic rhinitis in confirmed cases of CD and conducted pulmonary function testing in children aged 5 to 16 years while comparing them with controls. Study Design: Cross sectional study. Setting: Department of Pediatrics Medicine, Children Hospital Chandka Medical College / Shaheed Mohtarma Benazir Bhutto Medical University, Larkana. Period: From 1st January 2018 to 30th June 2018. Material & Methods: We enrolled 50 confirmed cases of CD along with 100 controls with non specific abdominal pain. All were aged 6 to 16 years, of both genders. Demographics as well as questions related to asthma and allergic rhinitis were noted. Results: Amongst a total of 150 children, 61 (40.7%) male and 89 (59.3%) female. Overall mean age amongst children was 9.80 years with standard deviation of 2.6 years. A total of 40 (26.7%) children who had weight below the 3rd percentile while 36 (24.0%) had height below the 3rd percentile. Most children, 82 (54.7%) had normal BMI. Weight below the 3rd percentile and height below the 3rd percentile were of statistical significance as children with a weight and height below the 3rd percentile were significantly higher in the CD group (P = 0.026 and P = 0.005, respectively). Asthma and allergic rhinitis characteristics were not much different between the two groups (p > 0.05). The Pulmonary function test (PFT) results showed that 7 (14.0%) cases with CD and 12 (12.0%) controls had obstructive pulmonary changes (p > 0.05). Conclusion: Rates of Asthma and allergic rhinitis in children having CD were not significantly higher in comparison to controls. No linkage between asthma and allergic rhinitis symptoms was seen children having CD.

Background Inflammatory stress caused by protein kinase D (PKD) plays a critical role in damaging chondrocytes and extracellular matrix (ECM) during osteoarthritis (OA). The PKD inhibitor (PKDi) (CRT0066101) has been used to overcome inflammation in different cell types. However, the efficacy of a therapeutic drug can be limited due to off-target distribution, slow cellular internalization, and limited lysosomal escape. In order to overcome this issue, we developed nanosomes carrying CRT0066101 (PKDi-Nano) and tested their efficacy in vitro in chondrocytes. Methods Chondrocytes were subjected to IL-1β-induced inflammatory stress treated with either PKDi or PKDi-Nano. Effects of treatment were measured in terms of cytotoxicity, cellular morphology, viability, apoptosis, phosphorylation of protein kinase B (Akt), and anabolic/catabolic gene expression analyses related to cartilage tissue. Results and Discussion The effects of PKDi-Nano treatment were more pronounced as compared to PKDi treatment. Cytotoxicity and apoptosis were significantly reduced following PKDi-Nano treatment (P < 0.001). Cellular morphology was also restored to normal size and shape. The viability of chondrocytes was significantly enhanced in PKDi-Nano-treated cells (P < 0.001). The data indicated that PKDi-Nano acted independently of the Akt pathway. Gene expression analyses revealed significant increases in the expression levels of anabolic genes with concomitant decreases in the level of catabolic genes. Our results indicate that PKDi-Nano attenuated the effects of IL-1β via the nuclear factor kappa-light-chain enhancer of activated B cells (NF-κB) pathway. Conclusion Taken together, these results suggest that PKDi-Nano can be used as a successful strategy to reduce IL1β-induced inflammatory stress in chondrocytes.

In this study, geopolymers were prepared using metakaolin (MK) raw material under different alkali activator moduli (SiO2/Na2O = 0.8, 1.2, 1.6, 2.0 M ratio) in order to analyze their capacity and mechanism for adsorbing cadmium (Cd2+) from solution. Instrumental analyses including X-ray diffraction (XRD), scanning electron microscopy (SEM) with energy dispersive spectroscopy (EDS), X-ray photoelectron spectroscopy(XPS), Fourier transform infrared (FTIR), and Brunauer-Emmett-Teller (BET) were performed to examine the mineralogical features of the MK and geopolymers before and after Cd2+ adsorption. The effect of initial pH, temperature, contact time, and initial concentration on Cd adsorption performance was studied to obtain the equilibrium isotherm. Kinetic data of the geopolymers fitted the pseudo-second-order kinetic model well. Moreover, the adsorption equilibrium data of Cd2+ adsorbed by the geopolymers fitted the Langmuir model better than the Freundlich model. The result shows that chemisorption dominates Cd2+ adsorption by geopolymers and that the adsorption capacity differs when prepared using different alkali-activated modulus agents. The geopolymer prepared using an alkali activator modulus of 0.8 M (molar ratio) exhibited the best Cd2+ adsorption performance with a maximum adsorption capacity of 70.3 mg g−1. The removal rate of Cd2+ by geopolymer still remained above 85% after five round of recycling.

BackgroundType 2 Diabetes-related medication errors are frequently reported from the hospitals and consequently are of major concern. However, such reports are insufficient when developing healthcare settings are pursued in literature. Keeping this inadequacy in mind, we therefore aimed to explore physicians' perceptions, experiences and expectations of medication errors when managing patients with Type 2 Diabetes Mellitus.MethodsA qualitative design was adopted. By using a semi-structured interview guide through the phenomenology-based approach, in-depth, face-to-face interviews were conducted. Physicians practicing at the medicine ward of Sandeman Provincial Hospital, Quetta, were purposively approached for the study. All interviews were audio-taped, transcribed verbatim, and were then analyzed for thematic contents by the standard content analysis framework.ResultsAlthough the saturation was reached at the 13th interview, we conducted additional two interviews to ensure the saturation. Fifteen physicians were interviewed, and thematic content analysis revealed six themes and nine subthemes. Mixed conceptualization and characterization of medication errors were identified. Medication errors were encountered by all physicians however poor understanding of the system, deficiency of logistics and materials were rated as barriers in reporting medication errors. Among contributors of medication errors, physicians themselves as well as dispensing and patient-related factors were identified. Physicians suggested targeted training sessions on medication error-related guidelines and reporting system. Parallel, establishment of an independent unit, involving the pharmacists, and strict supervision of paramedics to minimize medication errors was also acknowledged during data analysis.ConclusionWith a longer life expectancy and a trend of growing population, the incidences of medication errors are also expected to increase. Our study highlighted prescribing, dispensing and administration phases as contributing factors of medication errors. Although, physicians had poor understanding of medication errors and reporting system, they believed getting insights on guidelines and reporting system is essential. A review of admission and discharge reconciliation must be prioritized and a culture of teamwork, communication and learning from mistakes is needed.

A vital feature of conservative dentistry is the adhesion of the restorative material to the tooth structure for restoration of the tooth substance lost due to dental decay, trauma, or dental imperfections. In a perfect world, a restorative material should generate a lasting adhesion by bonding the restoration with tooth tissues. The ingress of micro-organisms, oral fluids, molecules, and ions through microscopic spaces due to faulty adhesion between restoration and tooth structure is known as microleakage. This study is focuses on the evaluation of adhesive failures between the restorative materials. In the past, studies have focused more on the bonding potential of a restorative material with the tooth surface. Therefore, there is need to carry out a study that compares the microleakage between resin-based restorative materials in a sandwich manner with and without the intermediate bonding layer after immersion in 2% methylene blue dye at different time intervals. The restorative materials used were composite Ceram X Mono plus (DENTSPLY) and Z350 (3M ESPE), Vitremer resin modified glass ionomer cement (RMGIC) (3M ESPE), smart dentine replacement SDR (3M ESPE), Bond NT (DENTSPLY), and Universal Bond (3M ESPE). A light emitting diode (LED) was used to cure the specimens. Artificial saliva was used as a storage medium for the specimens. Thermocycling of specimens was carried out at 500 cycles/30 s and 1000 cycles/30 s. The world health organization (WHO) grading tool for microleakage was used to analyze fluid ingress in the specimens through disclosing by 2% methylene blue dye. The statistical analysis was carried out with one-way analysis of variance (ANOVA) and Tukey post hoc test, keeping the level of significance at p ≤ 0.05. In Grade 0 = 85 samples, Grade 1 = 10 samples, Grade 2 = 7 samples, Grade 3 = 16 samples, and in Grade 4 = 2 samples were identified. This study describes that no microleakage was observed in SDR and resin composite groups as compared to Vitremer and resin composite groups.

This study intends to evaluate the effects of recruitment process on organizational performance along with mediating role of employee’s commitment in the manufacturing sector of Pakistan based on the social exchange theory. The study has collected data from 384 managerial staff of the manufacturing organizations in Hattar, Islamabad, and Lahore regions. The collected data was analyzed using multiple regressions to find results. The results of the study indicated that recruitment process has positive significant effects on the organizational performance and employee’s commitment in the manufacturing sector of Pakistan. The results have also indicated that employee’s commitment mediated the relationship between recruitment process and organizational performance in the manufacturing sector of Pakistan. However, this study is only limited to the manufacturing sector of Pakistan in the context of social exchange theory. This study has clarified the effects of recruitment process on the organizational performance along with the mediating role of employee’s commitment in the defined context. Concisely, by integrating recruitment process, organizational performance, and employee’s commitment literature, the main contribution of this article is the analysis of job specification, job description, job evaluation in enhancing the organizational performance in the manufacturing sector of Pakistan.

Novel drug targets for sustained reduction in body mass index (BMI) are needed to curb the epidemic of obesity, which affects 650 million individuals worldwide and is a causal driver of cardiovascular and metabolic disease and mortality. Previous studies reported that the Arg95Ter nonsense variant of GPR151, an orphan G protein-coupled receptor, is associated with reduced BMI and reduced risk of Type 2 Diabetes (T2D). Here, we follow up on GPR151 with the Pakistan Genome Resource (PGR), which is one of the largest exome biobanks of human homozygous loss-of-function carriers (knockouts) in the world. Among PGR participants, we identify 3 GPR151 putative loss-of-function (plof) variants (Arg95Ter, Tyr99Ter, and Phe175LeufsTer7) with a cumulative allele frequency of 2.2% and present at homozygosity. We confirm these alleles in vitro as loss-of-function. We test if GPR151 plof is associated with BMI, T2D, or other metabolic traits. GPR151 deficiency in complete human knockouts is not associated with a clinically significant difference in BMI. Moreover, loss of GPR151 confers a nominally significant increase in risk of T2D (odds ratio = 1.2, p value = 0.03). Relative to wild-type mice, Gpr151-/- animals exhibit no difference in body weight on normal chow, and higher body weight on a high-fat diet, consistent with the findings in humans. Together, our findings indicate that GPR151 antagonism is not a compelling therapeutic approach for obesity.

Drucker’s knowledge-worker productivity theory and knowledge-based view of the firm theory are widely employed in many disciplines but there is little application of these theories in knowledge-based innovation among academic researchers. Therefore, this study intends to evaluate the effects of the knowledge management process on knowledge-based innovation alongside with mediating role of Malaysian academic researchers’ productivity during the Pandemic of COVID-19. Using a random sampling technique, data was collected from 382 academic researchers. Questionnaires were self-administered and data was analyzed via Smart PLS-SEM. Knowledge management process and knowledge workers’ productivity have a positive and significant relationship with the knowledge-based innovation among academic researchers during the Pandemic of COVID-19. In addition, knowledge workers’ productivity mediates the relationship between the knowledge management process (knowledge creation, knowledge acquisition, knowledge sharing, and knowledge utilization) and knowledge-based innovation during the Pandemic of COVID-19. Results have also directed knowledge sharing as the key factor in knowledge-based innovation and a stimulating task for management discipline around the world during the Pandemic of COVID-19. This study provides interesting insights on Malaysian academic researchers’ productivity by evaluating the effects of knowledge creation, acquisition, sharing, and application on the knowledge-based innovation among academic researchers during the Pandemic of COVID-19. These useful insights would enable policymakers to develop more influential educational strategies. By assimilating the literature of defined variables, the main contribution of this study is the evaluation of knowledge creation, acquisition, sharing, and utilization into knowledge-based innovation alongside the mediating role of knowledge workers productivity in the higher education sector of Malaysia during the Pandemic of COVID-19.

Bergenia ciliate (B. ciliate) leaf extract was used as a reducing and stabilizing agent for the synthesis of silver-copper oxide nanocomposite (Ag-CuO NC). Scanning and transmission electron microscopies (SEM and TEM) were used to examine the structural morphology, and the average particle size was determined to be 47.65 nm. The phase confirmation and crystalline structure were examined through the X-ray diffraction (XRD) technique, where cubic and monoclinic geometries were assigned to Ag and CuO. The energy dispersive X-ray (EDX), Fourier transform infrared (FTIR) and ultra-violet and visible (UV-Visible) spectroscopies were operated to analyse the elemental composition, functional groups and light absorption phenomena of the Ag-CuO NC. Under the full light spectrum, the photodegradation of Rhodamine 6G was recorded, and 99.42 percent of the dye degraded in 80 min. The Agar well diffusion method was followed to perform antibacterial activity against selected pathogens, and the activity was found to increase with increasing concentration of Ag-CuO NC. The ABTS free radical scavenging activity suggests that the activity of Ag-CuO NC is higher than ascorbic acid.

Angiogenesis is critical for successful fracture healing. Age-related alterations in endothelial cells (ECs) may cause impaired bone healing. Therefore, examining therapeutic treatments to improve angiogenesis in aging may enhance bone healing. Sirtuin 1 (SIRT1) is highly expressed in ECs and its activation is known to counteract aging. Here, we examined the effects of SRT1720 treatment (SIRT1 activator) on the growth and function of bone marrow and lung ECs (BMECs and LECs, respectively), derived from young (3–4 month) and old (20–24 month) mice. While aging did not alter EC proliferation, treatment with SRT1720 significantly increased proliferation of all LECs. However, SRT1720 only increased proliferation of old female BMECs. Vessel-like tube assays showed similar vessel-like structures between young and old LECs and BMECs from both male and female mice. SRT1720 significantly improved vessel-like structures in all LECs. No age, sex, or treatment differences were found in migration related parameters of LECs. In males, old BMECs had greater migration rates than young BMECs, whereas in females, old BMECs had lower migration rates than young BMECs. Collectively, our data suggest that treatment with SRT1720 appears to enhance the angiogenic potential of LECs irrespective of age or sex. However, its role in BMECs is sex- and age-dependent.

This study aims to examine the effects of circular economy innovation and BMI (business model innovation) on SMEs (Small and Medium Enterprises) economic, environmental, and social performance along with the mediating role of government incentives in Pakistan, Malaysia, and China. Data were collected through a structured questionnaire in online survey from the owners, CEO, and senior managers of SMEs in Pakistan, Malaysia, and China, and analyzed using PLS-SEM. The results revealed that circular economy innovation and BMI have positive significant effects on SMEs economic, environmental, and social performance in Pakistan, Malaysia, and China. The study also found that government incentives have mediating effects on the relationship between circular economy innovation, BMI, and SMEs economic, environmental, and social performance in Pakistan, Malaysia, and China. This study provides interesting insights about SMEs economic, environmental, and social performance by evaluating the impacts of circular economy innovation, BMI, and amid mediation of government incentives. These useful insights will enable policy makers and practitioners to develop more effective strategies to enhance the economic, environmental, and social performance of SMEs. By reviewing the literature on circular economy innovation, BMI, and government incentives, the main contribution of this study is the evaluation and analysis of circular economy innovation, BMI, and government incentives as they affect SMEs economic, environmental, and social performance in Pakistan, Malaysia, and China. The theoretical and practical implications for academics and practitioners are displayed at the end of the study.

(1) Background: In this investigation, a composite of MgO nanoparticles with Itsit biochar (MgO-IBC) has been used to remove arsenate from contaminated water. The reduced adsorption capacity of biochar (IBC), due to loss of functionalities under pyrolysis, is compensated for with the composite MgO-IBC. (2) Methods: Batch scale adsorption experiments were conducted by using MgO-IBC as an adsorbent for the decontamination of arsenate from water. Functional groups, elemental composition, surface morphology, and crystallinity of the adsorbent were investigated by using FTIR, EDX, SEM and XRD techniques. The effect of pH on arsenate adsorption by MgO-IBC was evaluated in the pH range of 2 to 8, whereas the temperature effect was investigated in the range of 303 K to 323 K. (3) Results: Both pH and temperature were found to significantly influence the overall adsorption efficiency of MgO-IBC for arsenate adsorption with lower pH and higher temperature being suitable for higher arsenate adsorption. A kinetics study of arsenate adsorption confirmed an equilibrium time of 240 min and a pseudo-second-order model well-explained the kinetic adsorption data, whereas the Langmuir model best fitted with the equilibrium arsenate adsorption data. The spontaneity and the chemisorptive nature of arsenate adsorption was confirmed by enthalpy, entropy, and activation energy. Comparison of adsorbents in the literature with the current study indicates that MgO-IBC composite has better adsorption capacity for arsenate adsorption than several previously explored adsorbents. (4) Conclusions: The higher adsorption capacity of MgO-IBC confirms its suitability and efficient utilization for the removal of arsenate from water.

Our study used the full-potential linearized augmented plane waves (FP-LAPW) method to conduct a first-principles evaluation of the structural, electronic, and magnetic properties of ThMn2X2 (X = Si and Ge) compounds. To establish theoretical dependability with the currently available experimental results, computations for the structural findings of ternary intermetallic thorium (Th)-based compounds were achieved using the generalized gradient approximation in the scheme of Perdew–Burke–Ernzerhof (PBE–GGA) potential, while the generalized gradient approximation plus the Hubbard U (GGA + U) approach was employed to improve the electrical and magnetic properties. In contrast with both the paramagnetic (PM) and antiferromagnetic (AFM) phases, the ThMn2X2 compounds were optimized in a stable ferromagnetic (FM) phase, which was more suited for studying and analyzing magnetic properties. The electronic band structures (BS) and the density of state (DOS) were computed using the two PBE–GGA and GGA + U approximations. The thorium (Th)-based ThMn2X2 compound has full metallic character, due to the crossing and overlapping of bands across the Fermi level of energy, as well as the absence of a gap through both spin (up and down) channels. There was a significant hybridization between (Mn-d and (X = Si and Ge)-p states of conduction band with Th-f states in the valence band. The total magnetic moment of ThMn2Si2 in the ferromagnetic phase was 7.94534 μB, while for ThMn2Ge2 it was 8.73824 μB with a major contribution from the Mn atom. In addition, the ThMn2Ge2 compound’s total magnetic moment confirmed that it exhibits higher ferromagnetism than does the ThMn2Si2 compound.

Purpose The aim of this research is to understand how government incentives (financial and non-financial) influence the relationship between green innovation and Sustainable Development Goals (SDGs) in SMEs. Design/methodology/approach To contribute to the literature, this research uses empirical evidence of 204 Pakistani small and medium-sized enterprises (SMEs) and tests the moderating role of government support between green innovation and SDGs. Findings The findings indicate that green innovation has a significant influence on SDGs, community development and environmental activities. The government support significantly strengthens the relationship between green innovation and environmental practices, while it does not moderate the path between green innovation and community development. Practical implications The research recommends SMEs focus on the adoption of green innovation and green technology to protect the environment and facilitate the community. Moreover, the research advises the government to assist SMEs financially and nonfinancially, so they will in turn help in the attainment of SDGs. Originality/value This research is the first attempt to assess the importance of green innovation in SDGs with a moderating role of government incentives in emerging SMEs. It provides several useful implications for policymaking.

Background Genetic, lifestyle, and environmental factors can lead to perturbations in circulating lipid levels and increase the risk of cardiovascular and metabolic diseases. However, how changes in individual lipid species contribute to disease risk is often unclear. Moreover, little is known about the role of lipids on cardiovascular disease in Pakistan, a population historically underrepresented in cardiovascular studies. Methods We characterised the genetic architecture of the human blood lipidome in 5662 hospital controls from the Pakistan Risk of Myocardial Infarction Study (PROMIS) and 13,814 healthy British blood donors from the INTERVAL study. We applied a candidate causal gene prioritisation tool to link the genetic variants associated with each lipid to the most likely causal genes, and Gaussian Graphical Modelling network analysis to identify and illustrate relationships between lipids and genetic loci. Results We identified 253 genetic associations with 181 lipids measured using direct infusion high-resolution mass spectrometry in PROMIS, and 502 genetic associations with 244 lipids in INTERVAL. Our analyses revealed new biological insights at genetic loci associated with cardiometabolic diseases, including novel lipid associations at the LPL, MBOAT7, LIPC, APOE-C1-C2-C4, SGPP1, and SPTLC3 loci. Conclusions Our findings, generated using a distinctive lipidomics platform in an understudied South Asian population, strengthen and expand the knowledge base of the genetic determinants of lipids and their association with cardiometabolic disease-related loci.

Background: One of the most common gastrointestinal infections is Helicobacter pylori infection, which leads to gastritis, gastrointestinal ulcers, and eventually stomach cancer. Many chemical drugs are used to eradicate this bacterium; however, resistance to many drugs and recurrence of infection are some treatment problems. Among these, the role of herbal medicines is very important. Glycyrrhiza glabra and Salvia officinalis are some plants used to treat H. pylori infections. These plants grow in different regions of Iran, and it is important to study their effects on this bacterium. Objectives: Accordingly, this study aimed to isolate H. pylori strains and investigate the antimicrobial effects of G. glabra and S. officinalis ethanolic extract against this bacterium. Methods: Helicobacter pylori specimens were isolated from endometrium biopsy of the stomach of patients who referred to Sistan and Baluchestan Hospital by culture method. Then, the antimicrobial effects of the ethanolic extracts of G. glabra and S. officinalis were investigated on H. pylori isolates by microdilution method. Results: The results of this study showed that 30 (60%) cases were metronidazole-resistant, 15 (30%) were amoxicillin-resistant, 12 (24%) were tetracycline-resistant, and 2 (4%) were clarithromycin-resistant. While the lowest minimum inhibitory concentration (MIC) of G. glabra ethanolic extract against H. pylori was 3.1 mg/mL (five strains were inhibited), the highest minimum bactericidal concentration (MBC) was equal 100 mg/mL (six strains were inhibited). The lowest MIC of S. officinalis against H. pylori was equal 3.1 ppm (12 strains were inhibited), while the highest MBC was 50 ppm (one strain was inhibited). Conclusions: According to our results, G. glabra and S. officinalis ethanolic extracts had high antibacterial activity against antibiotic-resistant strains. Regarding the continuous and reckless use of chemical drugs, unfortunately, increasing drug resistance in germs is increasing compared to chemical drugs day by day, as a result, be used from medicinal herbs. On the other hand, as the environment (weather and soil area) is effective in the type and amount of phytochemical substances, therefore, it is suggested that when using a medicinal plant for the treatment of diseases, should be addressed to the location of the plant and the type of tissue of the plant to achieve the best Therapeutic effect.

AIM Delayed closure of ileostomy following an anterior resection for rectal cancer in the UK is common. The aims of this study were (i) to investigate the variation in patient pathways between hospitals, (ii) to identify the key learning points from units with the shortest time to closure and (iii) to develop guidance for a pathway to minimize delay in ileostomy closure. METHOD This was a mixed methods study. Thirty-eight colorectal units in the UK completed a short online survey. Nine colorectal units in Wales filled in an additional, expanded version of the survey. Semi-structured interviews were performed with clinicians from the six best performing units in terms of timely ileostomy closure. The optimal pathway suggested is based on the best evidence available and the Association of Coloproctology of Great Britain and Ireland guidelines. RESULTS Qualitative analysis revealed that 5% of units (n = 2) have a local target time for ileostomy closure. Of all units, 90% (n = 34) would consider implementing a pathway if guidelines were developed. In-depth interviews highlighted the importance of a multidisciplinary approach, a dedicated coordinator to facilitate timely booking, and consensus on whether closure should be performed before or after adjuvant chemotherapy. CONCLUSION There is a lack of national guidance in timing of contrast studies and ileostomy closure. Key aspects to consider are better information at consent regarding stoma closure timing, a dedicated person to track patients and the planning of contrast studies at discharge from initial surgery. With a dedicated approach closure of ileostomy within 10-12 weeks is feasible for most units.

This study was planned to synthesize a multifunctional nanomaterial that can effectively encounter the organic pollutants, multidrug-resistant bacteria and reactive free radicals. The Bergenia ciliate (B. ciliate) leaves extract was used as a reducing and capping agent for the synthesis of nickel oxide nanoparticles (NiO NP). The physicochemical properties were studied through X-ray diffractometre (XRD), energy dispersive X-ray (EDX), scanning electron microscopy (SEM), transmission electron microscopy (TEM), UV-visible and Fourier transform infrared (FTIR) spectroscopies. The highly crystalline monoclinic NiO NPs were synthesized with crystallite size of 27.45 nm. The average particle size derived from TEM micrograph was 49.35 nm whereas the calculated band gap for NiO NPs was 3.78 eV. The photocatalytic study shows that 92.17% of the rhodamine 6G (Rh-6G) was efficiently degraded in the presence of NiO NPs. The agar well diffusion method was applied to examine the antibacterial activity of NiO NPs and the activity was found higher against Gram-negative bacteria (GNB) as compared to Gram-positive bacteria (GPB). The ABTS free radical scavenging activity was also performed, however, the activity was found less than the standard.