Prevalence of Chronic Kidney Disease in a High-Risk Population in Urban Lahore, Pakistan: A Cross-sectional Study.

Background Chronic kidney disease (CKD) is a globally increasing health concern, and there is a growing focus on early screening and prevention efforts. However, the availability of data on CKD prevalence in Pakistan, particularly in the urban area of Lahore district, is limited. The objective of the Kidney Early Evaluation Program (KEEP) Lahore was to assess the prevalence of CKD in a high-risk population residing in the urban area of Lahore, Pakistan. Methods A cross-sectional study was conducted involving 254 participants, who were over 18 years old and belonged to a high-risk population according to the pre-defined operational definitions. The participants were randomly selected from various towns in Lahore. Screening camps were set up to measure serum creatinine levels and urinary albumin to creatinine ratio (UACR), and then the estimated glomerular filtration rate (eGFR) was calculated using the CKD Epidemiology Collaboration 2021 (CKD EPI) equation. Results Out of the total 254 participants, a diagnosis of CKD was made in 62 (24.2%) individuals. Significant associations were found between CKD and risk factors including hypertension, diabetes, family history of CKD, ischemic heart disease (IHD) or congestive heart failure (CHF), intake of painkillers, and herbal medicines. However, no association was found between obesity (BMI ≥ 30) and CKD. Participants diagnosed with CKD had a mean age of 49.9 years and a mean serum creatinine level of 1.2 mg/dL, while non-CKD participants had a mean age of 43.7 years and a mean serum creatinine level of 0.7 mg/dL. Conclusion Our study revealed that CKD was prevalent in about one-fourth of the participants from the high-risk population of Lahore, indicating a high prevalence of the disease within society. Moreover, hypertension, diabetes, family history of CKD, heart disease, painkillers, and the use of herbal medicines were all significantly linked to CKD in the surveyed sample population.

Trade agreements and CO2 emissions in Asian countries: accounting for institutional heterogeneity.

This paper aims to measure the impact of environmental provisions in free-trade agreements on pollution levels in 40 Asian economies for the period 1990-2019. Following the failure of WTO negotiations, there has been a rapid proliferation of preferential trade agreements incorporating various types of environmental clauses. We exploit such changes to assess their influence on pollution emissions. We use a DOLS approach that considers the potential endogeneity of environmental clauses. Further, panel vector error correction models (VECM) are employed for examining the presence of a cointegration relationship among the variables studied. Overall, our findings indicate that these environmental clauses have heterogenous effects on CO2 emissions. We do not find significant effects of environmental clauses on pollution. However, this result is driven by environmental provisions that are not legally enforceable. We do find a positive effect of environmental clauses with a higher level of legalism on the environmental quality. These results show that the inclusion of environmental provisions in trade agreements is not sufficient by itself. Such provisions should incorporate a legally enforceable framework to effectively address environmental concerns. These findings have significant policy implications for Asian countries.

Do institutional governance and state fragility affect institutional quality in Asian economies?

Institutional Quality (IQ) and Institutional Governance (IG) are multi-dimensional concepts influenced by many indicators, making them researchable. Moreover, IQ in Asia is trending due to a diversified economy and development pattern. This paper investigates IQ in 25 Asian countries from 2009 to 2020 by taking Country Policy and Institutional Rating as a proxy of Institutional Quality as a dependent variable, State Fragility (SF) determinants, and Institutional Governance (IG) as independent variables. The two-step GMM estimation shows that IG determinants, corruption control measures, political stability, and voice and accountability environment significantly impact IQ and development in Asian economies. On the contrary, External Intervention in policy and state affairs and SF have an adverse effect on the IQ and demote the country's development progress. It concludes that IQ in Asian economies has been substantially influenced by the IG and SF determinants.

Impact of COVID-19 pandemic on sustainability determinants: A global trend.

For the last six months till today, the world had had no luck in defeating COVID-19. This study examined the impact of the COVID-19 Pandemic on sustainability determinants, with the time arisen from December 27, 2019, through June 30, 2020. This study considers quantitative COVID-19 dashboard data with sustainable determinants; old age group, people exposed to air pollution, and countries with the most international travelers. Applying linear regression examines that COVID-19 behavior concerning the aging population and countries host the most international travelers, more positively significant than people exposed to PM2.5% air pollution, respectively. This study made a novel contribution by analyzing two variables' interaction; first, the aging population and the countries that host the most international travelers. Secondly, the aging population and people exposed to air pollution are vulnerable to COVID-19 globally, a novel concept comprehensively. Results show that countries with aging populations are more exposed to COVID-19, and its interaction term host the most international travelers. It also analyses that the aging population and its interaction with people exposed to air pollution are also vulnerable to COVID-19 but marginally lesser than the former. However, their behavior varies from country to country, making room for future study to analyze a more in-depth analysis. It gives a different dimension to consider other risk factors of COVID-19 by bearing in mind its unique contagious characteristics, which will help policymakers draft a sound epidemic preparedness policy to tackle the unforeseen crisis. It gives a thought of provoking to policy practitioners for the risk characteristics of COVID-19, which needs a reassessment to epidemic risk management to deal with this, and future unforeseen crisis by considering Sustainable Development Goals.