Assessment of potential drug-related problems (PDRP) and clinical outcomes in bacterial meningitis patients admitted to tertiary care hospitals.

Meningitis is an important cause of morbidity and mortality in children and adults. Its treatment strategy varies with age and gender. To assess potential drug-related problems (PDRP) and clinical outcomes in bacterial meningitis patients, a multicenter, clinical, descriptive, cross-sectional prospective observational study in 120 patients admitted to different tertiary care hospitals in Karachi was conducted. It includes both males 48% and females 52% belonging from all age groups i.e. peadiatrics (01 to 12 years), adults (18 to 65 years), and geriatrics (66 to 75 years). Out of these 72 patients were admitted in the public sector and 48 patients were admitted in private sector hospitals. Nosocomial infections were developed in 41% of patients during their stay at the hospital. Potentially nephrotoxic drugs were administered to all BM patients, these drugs should be administered carefully. Majorly Ceftriaxone was administered to 86% of patients, Vancomycin 71%, and meropenem 73% whereas 68% of patients were administered piperacillin-tazobactam. Organisms involved as causative agents in the majority of patients are Neisseria meningitides, Pseudomonas aeruginosa and, Streptococcus pneumoniae. DRPs impacted patient clinical outcomes in presence of many other factors like comorbidities, DDIs, Nis, administration of potentially nephrotoxic drugs, and administration of watch group and reserve group antibiotics without having culture sensitivity test, even after having CST no principles of de-escalation for antibiotics were done, which is a very important factor for hospitalized patients having IV antibiotics. The mortality rate among BM patients was 66%. The majority of patients (87%) stay at the hospital was 1-10 days. The present study helped in the identification of DRPs along with some other factors affecting the clinical outcomes in patients suffering from bacterial meningitis. Healthcare professionals should receive awareness and education on the importance of CST before initiating antibiotic therapy. Pharmacist-led medication review is necessary and should be followed to avoid negative outcomes and serious consequences related to DRPs.

Promoting pro-environmental behavior among one belt one road firms' employees through the lens of green human resource practices.

BACKGROUND: The realization of the China-Pakistan Economic Corridor (CPEC) has opened up new horizons for economic development along with threats to climate change in Pakistan. It has intended to change the social and corporate landscape, which necessitates investigation regarding corporate green HRM practices and employee behaviors of the firms involved. OBJECTIVE: This study developed a theoretical framework and investigated the mediating impact of pro-environmental psychological climate (PEPC) between green human resource management (GHRM) and pro-environmental behavior (PEB) of the employees working under CPEC in Pakistan. Therefore, the core intent lies in recognizing those aspects of manipulating the pro-environmental behavior of the employees of the firms involved. METHODS: Based on the simple random sampling technique, data was collected from 388 employees using a quantitative approach. SmartPLS was used to analyze the data. RESULTS: The findings suggest that GHRM practices have an impact on organizations' pro-environmental psychological climate and employees' pro-environmental behavior. Furthermore, the pro-environmental psychological climate encourages employees to engage in environmentally friendly behaviors within Pakistani organizations working under CPEC. CONCLUSION: GHRM has proved to be a vital instrument for attaining organizational sustainability and pro-environmental behavior. The original study results are particularly valuable for employees of the firms working under CPEC as they motivate them to engage in more sustainability solutions. The study findings add to the body of GHRM practices and strategic management, and thus policymakers can better postulate, align, and exercise GHRM practices.

Production performance, protein digestibility, gut health and economic efficiency in sexed broilers with super dozing of lysine.

Modern commercial broiler is growing very rapidly and its amino acid requirement is not fulfilling. An experimental trial was conducted to study the effect of super-dosing of lysine in fish meal-based diets (50% fish meal and 50% SBM) on production performance, protein digestibility and economic efficiency in male and female broiler chickens. Four hundred and eighty (480) one-day-old male and female broiler chicks were divided into forty experimental units of 12 birds each. Five levels of dietary lysine i.e. 90, 100, 110, 120 and 130% of Ross-308 recommendation in male and female birds were separately used. Weight gain and feed intake were higher (p < 0.05) in birds received 100 and 110% recommended lysine than other levels. Feed conversion ratio and EPEF were improved (p < 0.05) in birds received 100% recommended lysine than other levels. Higher (p < 0.05) CP digestibility and lower production cost per kg live weight were noted for birds fed diet containing lysine 100, 110 and 120% than 90 and 130%. Male birds had higher (p < 0.05) WG, FI, EPEF, protein digestibility and lower production cost per kg live weight than female birds. In conclusion, lysine levels below 100% and above 110% of Ross recommended levels had poor production performance, protein digestibility and economic efficiency.

Analyzing the determinants of sustainability of China Pakistan Economic Corridor (CPEC) projects: an interpretive structural modelling (ISM) approach.

China Pakistan Economic Corridor (CPEC) is a game changer initiative of South Asian Pacific Rim. It has great importance for almost all Asian countries. Its success is expected to dictate the economic development of the stakeholders. The aim of this study is to evaluate the essential determinants deriving the sustainability of CPEC projects. The design of the study comprises of the review of literature, data collection, and analysis. Population under study is the folk of stakeholders of CPEC. Sampling envisages on purposive sampling design, i.e., 14 experts from within the stakeholders. Primary data is collected in the field setting through a survey questionnaire appropriate for the study. ISM is used for modelling and MICMAC for analysis and classification using inductive approach. The findings of the literature survey show that there are 23 prime determinants of sustainability of CPEC projects. The results of ISM show that 13 determinants are at Level-I, nine at Level-II, and one determinant namely "economic globalization" is at Level-III being the most critical and driving determinant. The findings of MICMAC show that only one determinant is classified in independent quadrant, and all the remaining determinants are in linkage quadrant, whereas, no determinant is shown in autonomous and/or dependence quadrant. But most of the determinants have potential to be classified in dependent and independent quadrants. It is intimately evident that the results of MICMAC corroborate the results of ISM. It is useful for folk of the stakeholders by way of developing an understanding about the multitude of determinants, intra-determinant relations, prioritizing the determinants for policy decisions, and/or for building future studies. This study has some limitations, e.g., the study uses qualitative approach and answers what and how questions that do not quantify the relations or tell the cause of indicated relations.

Synthesis, characterization and assessment of antioxidant and antibacterial potential of dihydroquinoline-3-carboxylic acid and their metal derivatives.

Metal complexes of drug are used to inhibit growth of pathogenic microorganisms and reduces drug resistance. Moxifloxacin is a dihydroquinoline-3-carboxylic acid 4th generation fluoroquinolone antibiotic that has tendency to bind with metal ions. In current study four moxifloxacin-metal complexes i.e. Moxifloxacin-sliver (Moxi-Ag), Moxifloxacin-rhodium (Moxi-Rh), Moxifloxacin-titanium (Moxi-Ti) and Moxifloxacin-rubidium (Moxi-Rb) have been synthesized and evaluated for antibacterial activities against resistant microorganisms along with antioxidant effects. The structure elucidation was carried out using FTIR, 1H- NMR and UV-Vis spectroscopy. Agar well diffusion method and DPPH (1, 1- dipheny1-2-picrylhydrazyl) methods were used to study the antibacterial and antioxidant activity respectively. Both 1H NMR and FTIR spectra clearly showed that Moxi-metal complexes are formed due to change in their carboxyl stretching band in IR, H-2 and H-5 peak position in 1H NMR. All the Moxi-metal complexes showed distinguished antibacterial effects against both Gram-negative and Gram-positive bacteria as compared to drug which was found resistant against many microorganisms. Moxi-Rb and Moxi-Ag metal complexes showed higher antioxidant activity (IC50 values range from 8.26 - 9.19 µg/ml) than Moxi-Ti and Moxi-Rh metal complexes (IC50 range from 11.23 - 14.65 µg/ml).

Surge in Economic Growth of Pakistan: A Case Study of China Pakistan Economic Corridor.

China Pakistan Economic Corridor (CPEC) is considered a massive investment that can change the economic scenario of Pakistan. The purpose of the study is to examine the contribution to the economic growth of the sectors where CPEC is investing. This research uses time-series data for 31 years to investigate the impact of macro-economic variables like foreign direct investment (FDI), human capital investment (HCI), transport investment, and information communication technology (ICT) on the economic growth of Pakistan. The results of Fully Modified Ordinary Least Square Regression Specification (FMOLS) show a positive nexus between FDI, HCI, and economic growth while economic growth and ICT show a negative relationship. The results for the impact of transportation infrastructure on economic growth are statistically insignificant. This research suggests that an increased focus on building knowledge, expertise, and skillset of human resources will help in reaping the benefits of CPEC's investment. Future researchers can increase the period of the study to ascertain the implicit or explicit impact of CPEC on economic growth. The results also suggest that policymakers and researchers should focus on developing human capital to reap the investment benefits of CPEC.

Towards dealing with commonly occurring requirements engineering process issues during software development outsourcing.

Due to specific advantages, the volume of Software Development Outsourcing (SDO) is rapidly increasing. Because of challenges arising from the Requirements Engineering (RE) process, the anticipated benefits of SDO are not achieved in case of several projects. The objective of this research work is to recommend RE practices for addressing the commonly arising RE process issues in the case of SDO. For this reason, a thorough literature review has been undertaken, as well as two questionnaire surveys have been performed with skilled SDO industry practitioners. The surveys have been done by utilizing semi-supervised style and employing Convenience Sampling method. The 50 percent rule and a four-point Likert Scale have also been used to determine the advantages of RE practices for dealing with the issues. A comprehensive list of 147 RE practices has been extracted by conducting a Focus Group session. Furthermore, the 147 RE practices have been ranked by applying Numerical Assignment and Hundred Dollar Techniques during two Focus Group sessions. The detection and adaptation of RE practices aids in enhancing the SDO RE process, evading SDO failures, and achieving the associated SDO advantages.

Evaluating the socio-demographic, economic and clinical (SDEC) factors on health related quality of life (HRQoL) of hypertensive patients using EQ-5D-5L scoring algorithm.

This study was conducted to determine the various socio-demographic, economic, and clinical variables (SDECVs) which influence the health-related quality of life (HRQoL) of hypertensive patients. Three hundred and fifty hypertensive patients participated in this study through a structured questionnaire and EQ 5D 5L. 211(60.28%) participants had stage 1, and 139 (39.7%) had stage 2 hypertension. No participants reported severe problems in any domain on EQ 5D 5L. Generalize Linear Model (GLM) was used to assess the association between HRQoL and SDECVs. The mean utility and VAS score was 0.64 (±0.15) and 63.17 (±11.01) respectively. The participants of the stage 1 hypertension group had a significantly better score on each domain of EQ 5D 5L as compared to stage 1 (0.027, 0.010, 0.00, 0.00, 0.048). No participant in either group reported extreme problems in any domain. Among socio-demographic factors, the males, non-smokers, income sharing, and healthy normal hypertensive patients had better HRQoL (0.009, 0.016, 0.019, and 0.003). A lower cost of treatment was also associated with better HRQoL (0.017). Among clinical variables, stage 1 hypertension had better HRQoL than stage 2(0.035). The number of prescribed antihypertensive drugs had no effect on the quality of life (0.253), however, the non-pharmacologic interventions such as reduction in salt and oil consumption (0.035), reduction in beverages consumption (0.0014) and increased water intake (0.010) had resulted in better QoL. The patients who reported dizziness had poor HRQoL while patients who had cardiac problems and diabetes reported a significantly lower EQ-VAS score. The effect of gender on the HRQoL of hypertensive patients who had comorbid conditions was significant in the case of renal, respiratory, visual problems, and dizziness where females had a lesser utility score than males. The study reports on significant determinants which should be taken into account in an attempt to improve the health-related quality of life of hypertensive patients.

A Journey From SARS-CoV-2 to COVID-19 and Beyond: A Comprehensive Insight of Epidemiology, Diagnosis, Pathogenesis, and Overview of the Progress into Its Therapeutic Management.

The 2019 novel coronavirus (2019-nCoV), commonly known as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) or coronavirus disease 2019 (COVID-19), was first revealed in late 2019 in Wuhan city, Hubei province, China. It was subsequently spread globally and thereby declared as a pandemic by WHO in March 2020. The disease causes severe acute respiratory illness and is highly contagious due to the fast-onward transmission. As of the mid of November 2020, the disease has affected 220 countries with more than 16 million active cases and 1.3 million deaths worldwide. Males, pregnant women, the elderly, immunosuppressed patients, and those with underlying medical conditions are more vulnerable to the disease than the general healthy population. Unfortunately, no definite treatment is available. Although remdesivir as an antiviral had been approved for use in those above 12 years of age and 40 kg weight group, it has been observed to be ineffective in large-scale SOLIDARITY trials by WHO. Moreover, dexamethasone has been found to increase the recovery rate of ventilated patients; oxygen and inhaled nitric oxide as a vasodilator have been given emergency expanded access. In addition, more than 57 clinical trials are being conducted for the development of the vaccines on various platforms. Two vaccines were found to be significantly promising in phase III results. It is concluded that till the approval of a specific treatment or development of a vaccine against this deadly disease, the preventive measures should be followed strictly to reduce the spread of the disease.

Pharmacokinetics and bioequivalence assessment of optimized directly compressible Aceclofenac (100 mg) tablet formulation in healthy human subjects.

The aim of the study was to determine the various pharmacokinetic parameters of the newly developed cost-effective aceclofenac 100 mg tablet formulation (F-15) and to establish the bioequivalence against the marketed brand (ACEMED). Both products (test and reference) were given to 12 healthy non-smokers male subjects with overnight fasting of >10hr. The study was a randomized, single-dose, open-label, two sequence, and two treatment crossover design, with a washout period of 2 weeks. Blood samples (5 mL) from the human subjects were collected before (0 hr) and after drug administration at 13different time points (0.5, 1, 1.5, 2, 2.5, 3, 3.5, 4, 5, 6, 8, 12 and 18 hrs). The drug plasma concentration was analyzed by a validated RP-HPLC method using a solvent system containing acetonitrile and deionized water (60:40% v/v). Linearity was found to be 0.999 over the drug concentration range of 50µg/mL to 0.05µg/mL with LLOQ and LOD of 0.05µg/mL and 0.025µg/mL respectively. Non-compartmental pharmacokinetic analysis was performed using Kinetica® (ver. 5.1) software. Using the log-transformed data Cmax, AUC0-t, AUC0-∞, AUMCtot, and MRT were calculated. The Cmax of the test and brand was found to be 8.629±1.251µg/mL and 8.478±0.913µg/mL. The AUC0-t and AUC0-∞ of the test and the reference were computed to be 20.890 ±2.2021µg/mL.h, 23.272 ±1.914 µg/mL.h and 19.850 ±2.911 µg/mL.h, 22.890 ± 2.110 µg/mL.h correspondingly. Two-way analysis of variance (ANOVA) test and two one-sided t-test (p>0.05; non-significant) were applied to assess the variation in the period, sequence, subjects, and treatment. Geometric mean ratios for above mentioned pharmacokinetic parameters of reference/test were found within the acceptable FDA limits of 80-125% using 90% CI. There was no inter and intrasubject variation (p> 0.05) that was observed. Therefore, the directly compressible aceclofenac (100 mg) test formulation and the commercial reference tablets were declared to be biosimilar.

Requirements engineering issues causing software development outsourcing failure.

Software development outsourcing is becoming more and more famous because of the advantages like cost abatement, process enhancement, and coping with the scarcity of needed resources. Studies confirm that unfortunately a large proportion of the software development outsourcing projects fails to realize anticipated benefits. Investigations into the failures of such projects divulge that in several cases software development outsourcing projects are failed because of the issues that are associated with requirements engineering process. The objective of this study is the identification and the ranking of the commonly occurring issues of the requirements engineering process in the case of software development outsourcing. For this purpose, contemporary literature has been assessed rigorously, issues faced by practitioners have been identified and three questionnaire surveys have been organized by involving experienced software development outsourcing practitioners. The Delphi technique, cut-off value method and 50% rule have also been employed. The study explores 150 issues (129 issues from literature and 21 from industry) of requirements engineering process for software development outsourcing, groups the 150 issues into 7 identified categories and then extricates 43 customarily or commonly arising issues from the 150 issues. Founded on 'frequency of occurrence' the 43 customarily arising issues have been ranked with respect to respective categories (category-wise ranking) and with respect to all the categories (overall ranking). Categories of the customarily arising issues have also been ranked. The issues' identification and ranking contribute to design proactive software project management plan for dealing with software development outsourcing failures and attaining conjectured benefits of the software development outsourcing.

Assessment of Water Quality Profile Using Numerical Modeling Approach in Major Climate Classes of Asia.

A river water quality spatial profile has a diverse pattern of variation over different climatic regions. To comprehend this phenomenon, our study evaluated the spatial scale variation of the Water Quality Index (WQI). The study was carried out over four main climatic classes in Asia based on the Koppen-Geiger climate classification system: tropical, temperate, cold, and arid. The one-dimensional surface water quality model, QUAL2Kw was selected and compared for water quality simulations. Calibration and validation were separately performed for the model predictions over different climate classes. The accuracy of the water quality model was assessed using different statistical analyses. The spatial profile of WQI was calculated using model predictions based on dissolved oxygen (DO), biological oxygen demand (BOD), nitrate (NO3), and pH. The results showed that there is a smaller longitudinal variation of WQI in the cold climatic regions than other regions, which does not change the status of WQI. Streams from arid, temperate, and tropical climatic regions show a decreasing trend of DO with respect to the longitudinal profiles of main river flows. Since this study found that each climate zone has the different impact on DO dynamics such as reaeration rate, reoxygenation, and oxygen solubility. The outcomes obtained in this study are expected to provide the impetus for developing a strategy for the viable improvement of the water environment.

Out of pocket (OOP) cost of treating hypertension in Karachi, Pakistan.

Pakistan is categorized to below to middle income countries where two third of the national annual health expenditure is in the form of out of pocket (OOP) cost. A prevalence based study was conducted to determine the OOP cost treatment of hypertension in Karachi by interviewing 350 hypertensive patients aged >30 years through a validated questionnaire. Hypertension (HTN) was classified into stage 1 and stage 2 and was found to be common in females (53.42%) than males (46.57%). The total costs of stage 1and stage 2 HTN were calculated to be 217869.7PKR and17545457.6 PKR respectively. The average treatment cost of stage 1 was observed to be significantly lower (p=0.006) than the cost of stage 2 HTN. Moreover; the cost of antihypertensive drugs, physician fees and laboratory tests were considerably different however; no variation was seen in cost of transport and loss of productivity through absenteeism from work. Overall, the present study indicates that the antihypertensive treatment has imposed a high burden on the pocket of common man and this is a major reason for treatment non-adherence. Consequently, it increases the risks of cardiovascular events, morbidity and mortality. Therefore, effective strategic planning is need of time to reduce OOP cost for better control on hypertension in Pakistan.

In-vitro assessment of cytotoxicity of halloysite nanotubes against HepG2, HCT116 and human peripheral blood lymphocytes.

Halloysite is a clay mineral with chemical similarity to kaolin, a pharmaceutical ingredient. It consists of mainly aluminosilicate nanotubular particles in the size range of ∼ 200-1000 nm. Many studies have tried to empirically explore this novel clay for its potential in drug delivery systems but no work has yet studied its cytotoxicity from the perspective of oral drug delivery system. In this study, the halloysite nanotubes (HNTs) were subjected to size distribution analyses, which reveal more than 50% of nanotubes in the size range of 500 nm and rest mainly in the sub micrometer range. HNTs were then evaluated for in-vitro cytotoxicity against HCT116 (colorectal carcinoma) and HepG2 (hepatocellular carcinoma) cells which represent the earliest entry point and the first accumulating organ, respectively, for nanoparticles en-route to systemic circulation after oral delivery. Moreover, HNTs were tested for their cytogenetic toxicity against human peripheral blood lymphocytes. Both these results collectively indicated that HNTs are generally safe at practical concentrations of excipients for oral dosage forms.