Green finance in circular economy: a literature review.

Developing markets are using sustainable development potential to reach zero-carbon goals. Due to the limitation of natural resources, companies need to use environmentally friendly manufacturing to develop a circular economy (CE). Green finance (GF) and the CE are linked in a systematic and complex approach; therefore, it was essential to employ the coupling coordination-level framework to explain their relationship and feedback. Any study linking green financing and CE together has been found. The objective of this research is to explore this twofold domain and determine its main characteristics. To address this objective, a comprehensive review of the literature was conducted, supplemented by a bibliometric analysis. The results confirm that GF has the potential to help society, sustainability, and the prevention to climate shifts, investing in the CE. There are many hurdles to overcome, including inadequate knowledge about CE and GF, ambiguous definitions, a lack of coherence between legal frameworks on CE and green financing, unclear laws, and a lack of financially viable motivation for investors and financial institutions that are ready to promote in sustainability. This study explores CE and GF domains. Managers may readily increase their understanding of methods, strategies, and technical solutions beneficial to assist their operations toward a green economy depending on various CE and GF elements. Finally, based on a categorization of GF types, the assessment identifies future investment potential consequences of green financing in the CE.

Opportunities and constraints for cleaner production policy in the developing world: a case study of Sindh Region, Pakistan.

The current industrial and economic activities in Sindh Province, Pakistan, polluted the region's water, air, soil, and marine resources. However, there is a rising demand for eco-friendly production, and it is important to develop new policies and tools to combat environmental degradation and enhance economic development. Cleaner Production (CP) provides opportunities to address many of these issues. Employed method for this study was based on three approaches: a literature review and stakeholder mapping; a collection of data and information from key stakeholders through focal group discussions, consultative workshops, and one-on-one meetings; and analysis and synthesis of data that were gathered from different sources. The analysis of collected information provides an overview of CP strategies moving forward. Participant workshops gave in-depth information on policy implementation, technological impediments to methods that have been employed elsewhere, and needed capacity building as well as financial consequences of policy implementation. Through increasing financial resources and institutional resources, the expansion of CP will help to replace the conventional methods of waste treatment with an eco-efficiency approach to preventing pollution at the source, thus reducing the need for expensive pollution control and management costs for environmental compliance. Experiences, achievements, and implementation pitfalls from this study can provide a lesson to other developing countries to improve their economic and environmental sustainability.

Causes of Acute Peritonitis and Its Complication.

Introduction Peritonitis is a significant cause of morbidity and mortality in surgical settings. Coexisting premorbid illness and postoperative complications were found to be associated with death. This study aimed to analyze various etiologies that cause peritonitis and shed light on the factors responsible for unsatisfactory results. Method This longitudinal study included 309 patients above 12 years of age, of either gender, with confirmed diagnosis of peritonitis. Exploratory laparotomy was done to identify the cause of peritonitis. Patients were monitored postoperatively till their discharge or death for the development of complications. Results Our results showed that the most common cause of acute peritonitis was duodenal perforation (26.2%), followed by typhoid ileal perforation (24.2%) and ruptured appendix (16.8%). At least one complication was observed in 31% of the participants. The most common complication was dehydration (18.8%), followed by septicemia (11.3%) and paralytic ileus (6.4%). Ten (3.2%) patients died in the hospital. Conclusions Acute peritonitis is a serious surgical emergency caused by a number of diseases. Early surgical treatment along with antibiotics, followed by aggressive resuscitation can yield improved outcomes in patients with peritonitis.

Frequency of Ophthalmological Findings in Hospitalized COVID-19 Patients.

INTRODUCTION: The symptoms of coronavirus disease-19 (COVID-19) may range from mild to severe. Patients usually present with fever, cough, and other respiratory tract symptoms, but may also be asymptomatic. Some studies have also indicated the ocular involvement by the virus. This study aims to look deeply into all ophthalmic findings seen in COVID-19 patients and their clinical characteristics. METHODS: This longitudinal study was conducted in the COVID-19 unit of a tertiary care hospital, Pakistan. Data of patients hospitalized with COVID-19 infection between July 2020 and March 2021 were included in the study. Ophthalmological examination was done at the time of admission and was repeated every alternate day to look for any ophthalmological manifestation. RESULTS: Out of 441 (n= 441), 61 (13.8%) participants had ophthalmological findings on examination. Patients with ophthalmological findings were significantly younger compared to patients without ophthalmological findings (42 ± 6 years vs. 44 ± 7; p-value, 0.03). C-reactive protein (CRP) was also significantly higher in patients with ophthalmological findings (122.2 ± 16.2 vs. 112.8 ± 19.8; p-value, 0.005). The most common ophthalmological finding was conjunctival irritation (50.8%), followed by diplopia (27.8%) and cotton wool spots (27.8%). CONCLUSION: Ophthalmological findings are prevalent in patients with COVID-19. In this study, patients with higher CRP levels were associated with ophthalmological findings. It is important to conduct ophthalmological examinations in patients with COVID-19, as they may give a clue about other complications associated with COVID-19.

Peripheral Artery Disease as a Predictor of Coronary Artery Disease in Patients Undergoing Coronary Angiography.

Background Peripheral artery disease (PAD) may be a useful tool to predict coronary artery disease (CAD) in patients undergoing coronary angiography. If proven that PAD can be a good predictor of CAD, it can help in early and cost-effective diagnosis of CAD. Methodology This observational study was conducted from January 2020 to February 2021 in the cardiology unit of a tertiary care hospital. Participants older than 40 years, with a history of uncontrolled hypertension and unstable angina, who warranted the need of angiography were enrolled in study. After enrollment and recording history, these cases were assessed for the presence of PAD based on ankle brachial index (ABI). ABI values less than 0.9 were labelled as participants with PAD. Then these cases underwent coronary angiography at the same institute, and the presence of greater than 50% stenosis of any coronary vessel on angiography was taken as positive CAD. Results In this study, PAD was identified in 152 (62.8%) participants. A total of 165 (68.1%) participants had greater than 50% stenosis on angiography. Out of 152 participants with ABI less than 0.9, 140 had greater than 50% stenosis on angiography. In total, 90 participants had ABI more than 0.9, of which 35 participants had greater than 50% stenosis. Sensitivity of PAD in predicting coronary artery stenosis was 80.0% (95% confidence interval [CI]: 73.30%-85.66%), specificity was 82.09% (95% CI: 70.80%-90.39%), and accuracy was 80.58% (95% CI: 75.02%-85.37%). Conclusions Our study demonstrated that the sensitivity, specificity, and accuracy of PAD in predicting coronary artery stenosis were significant. Hence, we conclude that PAD can be an excellent predictor of CAD by helping in early and cost-effective diagnosis of CAD.

Prevalence of Irritable Bowel Syndrome and Frequency of Symptoms in the General Population of Pakistan.

INTRODUCTION: Irritable bowel syndrome (IBS) is a chronic and debilitating functional gastrointestinal disorder. Risk factors include infective enteritis, female sex, antibiotic exposure, anxiety, and depression. The aim of this study is to find out the prevalence of IBS in healthy population and determine the characteristics of symptoms. MATERIAL AND METHODS: A cross-section study was conducted in the internal medicine unit of a tertiary care hospital in multiple cities of Pakistan. Eight hundred (800) healthy peoples were selected for study from June 2019 to August 2019. Diagnosis of IBS was made by using Rome III criteria. RESULTS: The prevalence of irritable bowel syndrome (IBS) in general population in our study was 33.2%. IBS was more common in females compared to males (57.7% vs. 42.2%; p value = 0.009). IBS was more common in age group between 20 and 29 years (45.5%). Among patient diagnosed with IBS in this study, the most common was bloating (74.7%) followed by increased stool frequency (54.4%). CONCLUSION: IBS is very prevalent in Pakistan, yet there is very little data and awareness related to it. Any change in stool frequency or consistency in young adults, especially women, shall be evaluated for IBS after ruling out other diseases. Early diagnosis and treatment of IBS will assist in improving the patient's quality of life.

Prevalence and Symptom Characteristics of Irritable Bowel Syndrome Among Bronchial Asthma Patients in Pakistan.

INTRODUCTION: Irritable bowel syndrome (IBS) is a common gastrointestinal disorder that leads to a variety of symptoms including abdominal discomfort and change in stool frequency and consistency. Asthma is a common disease of the airway. Some studies have suggested that a relationship between IBS and asthma exist, while others have contradicted the claim. This study aims to determine the prevalence of IBS in asthmatic patients and compare their symptoms with symptoms of IBS patients in non-asthmatic patients. METHODOLOGY: In this case-control study, 100 known and documented asthmatic patients were included as cases, and 100 non-asthmatic healthy patients were included as controls from July to August 2019. These patients were given a questionnaire based on ROME II criteria for the diagnosis of IBS. Prevalence and symptoms of IBS were compared between cases and controls. A probability level, P < 0.05 was considered significant.  Result: IBS was found in 41 out of 100 asthma patients (41%) and 18 out of 100 controls (18%) with a P-value of 0.0005 and was more common in females in both asthmatic (63.41%) and non-asthmatic patients (66.66%). Symptoms such as abdominal pain/distress (63.41% vs. 11.11%, P-value: 0.0013) and bloating (82.92% vs. 33.33%, P-value: 0.0005) were significantly higher in asthmatic patient with IBS compared to non-asthmatic patient with IBS. CONCLUSION: Prevalence of IBS among asthma patients was significantly higher as compared to non-asthmatics. Routine screening of asthma patients and further studies to understand the pathogenesis underlying association between IBS and asthma should be conducted to detect and manage such patients effectively.

Dissolution enhancement of felodipine by amorphous nanodispersions using an amphiphilic polymer: insight into the role of drug-polymer interactions on drug dissolution.

CONTEXT: Felodipine, a poorly soluble drug, is widely used in the treatment of angina pectoris and hypertension. OBJECTIVE: This study aimed at the preparation of amorphous solid dispersion (SD) of felodipine using an amphiphilic polymer, soluplus, for the potential enhancement in solubility of the drug. MATERIALS AND METHODS: Solid dispersions with varying proportions of drug and soluplus were prepared and the rate and extent of dissolution from SDs was compared with that of the pure drug. FT-IR and (1)H NMR spectroscopic analysis were carried out to examine the formation mechanism of SDs. Various techniques were used for solid state characterization of designed SDs. RESULTS: Formation of amorphous solid dispersions with particle size in nanometer range indicated suitability of polymer and method used in the preparation. FT-IR and (1)H NMR spectroscopy revealed that soluplus was involved in strong hydrogen bonding with felodipine molecules which resulted in the conversion of crystalline felodipine into amorphous form. Solid dispersion with 1:10 drug/polymer ratio showed more than 90% drug dissolution in 30 min whereas pure felodipine showed less than 19% drug dissolution in 1 h. DISCUSSION AND CONCLUSION: Amorphous SDs of felodipine were prepared using soluplus resulting in substantial enhancement in the rate and extent of dissolution of felodipine.