Early post-operative outcomes of robot-assisted pyeloplasty in patients with unilateral ureteropelvic junction obstruction.

INTRODUCTION: Ureteropelvic junction obstruction (UPJO) is a commonly encountered abnormality and it can lead to serious consequences such as renal dysplasia eventually resulting in loss of kidney. Hence, early diagnosis and timely management remains the cornerstone of the treatment. The most anticipated technique amongst modern day urologist is the robot-assisted laparoscopic pyeloplasty (RALP). The study aims to determine early post-operative outcomes of robot-assisted laparoscopic transperitoneal pyeloplasty procedure in patients presenting with unilateral ureteropelvic junction obstruction to establish the local perspective. METHODOLOGY: This is a descriptive study involving patients with ureteropelvic junction obstruction in a tertiary care facility in Karachi; Sindh Institute of Urology and Transplant (SIUT). A total of 46 participants were recruited. Robot-assisted laparoscopic transperitoneal dismembered Hynes-Anderson pyeloplasty was performed by a single surgeon with over 3 years of experience in the presence of the researcher. Early postoperative outcome total operative time, length of hospital stay, console time and blood loss were noted by the researcher as per operational definition. Data were analyzed on SPSS Version 22. RESULTS: Mean age in our study was 46.51 years with the standard deviation of ± 10.87. Whereas, mean length of hospital stay, total operative time, total blood loss, console time, pre-hemoglobin, posthemoglobin, height, weight and BMI in our study was 1.19 ± 0.40 days, 64.58 ± 17.59 min, 9.56 ± 6.13 ml, 30.17 ± 4.99 min, 12.66 ± 1.47 ml, 11.79 ± 1.93 ml, 165.62 ± 8.23 cm, 68.34 ± 8.23 kg and 24.85 ± 3.34 kg/m2, respectively. CONCLUSION: Recent advancements in technology have yielded the latest RALP technique which has been proven significantly better than existing approaches and similar results are reported by this study demonstrating improvement in peri-operative and post-operative outcomes ultimately ameliorating the quality of life of patients with UPJO.

Epidemiological and economic consequences of lumpy skin disease outbreaks on farm households in Khyber Pakhtunkhwa, Pakistan.

The livestock sector plays a crucial role in sustaining the livelihoods of millions of families across the world, especially in developing countries. However, farming households that rely on agriculture and livestock are particularly susceptible to the impacts of various infectious diseases and natural disasters. This study focuses on estimating the economic burden imposed on households by lumpy skin disease (LSD) in Pakistan and explores the effect of various socioeconomic factors on mortality ratio. Data were collected through a questionnaire survey from 406 farmers and were analyzed through descriptive statistics to calculate the monetary losses. In addition, the study employed fractional probit regression to identify factors affecting mortality ratio. The results demonstrate significant economic impacts of LSD on farm households in Pakistan, leading to direct and indirect losses and reduced milk productivity. Exotic cows were found to be more susceptible to mortality compared to indigenous cows. The study also found that farmers' education, experience, household income per month, vaccination, domestic-commercial, commercial animals, and access to information were negatively associated with mortality. The findings of this study emphasize the need for preventative measures such as affordable vaccines, treatment, and improved livestock health and welfare to mitigate the negative effects of LSD on farmers' income and the local economy.

Validation of translated Obstetric Quality of Recovery (ObsQoR-10A) score after nonelective cesarean delivery (CD) in an Arabic-speaking population.

Background: The ObsQoR-11 is a validated scale that assesses recovery after cesarean delivery (CD). This observational study aimed to evaluate the psychometric properties of its Arabic version. Methods: The original ObsQoR-11 was translated into an Arabic version (ObsQoR-10A). All participants completed the ObsQoR-10A at 24 h and 48 h postoperatively after CD. Validity, reliability, responsiveness, and feasibility were assessed. Results: The ObsQoR-10A correlated with Global Health Numerical Rating Scale (NRS) at 24 h (R = 0.68, 95% CI: 0.56-0.80, P < 0.001) and at 48 h (R = 0.66, 95% CI: 0.54-0.78, P < 0.001) and differentiated between good and poor recovery (median scores at 24 h 88 vs. 71, P < 0.001; at 48 h 95.5 vs. 70, P < 0.001). ObsQoR-10A correlated with hospital length of stay at 24 h (R = -0.21, 95% CI: -0.40 to -0.02, P = 0.03) and at 48 h (R = -0.21, 95% CI: -0.40 to -0.03, P = 0.02); gestational age at 24 h (R = 0.22, 95% CI: 0.03-0.40, P = 0.02); change in hemoglobin at 24 h (R = -0.30, 95% CI: 0.51 to -0.10, P < 0.01); and total opioids at 48 h (R = -0.45, 95% CI: -0.62 to -0.27, P < 0.001). There was a significant difference between 24 h and 48 h postoperative ObsQoR-10A scores (median difference: -18; P < 0.001 which shows responsiveness). Other key measures included a Cronbach's alpha of 0.87, split-half 0.75, and intra-class correlation >0.62 with no floor or ceiling effects. Median (IQR) completion time was 3 (3-5) and 3 (2.5-3.5) minutes at 24 h and 48 h. Conclusions: ObsQoR-10A is a valid, reliable, responsive, and a clinically feasible tool in an Arabic-speaking obstetric population.

Does board diversity reduce the probability of financial distress? Evidence from Chinese firms.

This paper empirically investigates the impact of cognitive board diversity in education, expertise, and tenure facets on financial distress likelihood in the emerging economy of China. This study examines how this relationship varies across State-Owned Enterprises (SOEs) and Non-State-Owned Enterprises (NSOEs). Paper argues that the Chinese stock market, as a typical emerging market, is an excellent laboratory for studying the impact of board diversity on the probability of financial distress. Its underdeveloped financial system and inadequate investor protection leave firms unprotected from financial hardship. A sample of 12,366 observations from 1,374 firms from 2010 to 2018 shows that cognitive diversity qualities are positively linked with Z-score, implying that directors with different educational backgrounds, financial skills, and tenures can assist in reducing the probability of financial distress. Cognitive board diversity reduces the likelihood of financial distress in SOEs and NSOEs. However, tenure diversity is insignificant in all cases. Furthermore, the robustness model "two-step system Generalized Methods of Moments (GMM)" demonstrated a positive association between educational diversity, financial expertise, and financial distress scores. The results have significant implications for researchers, managers, investors, regulators, and policymakers.

Effect of Online Reviews and Crowd Cues on Restaurant Choice of Customer: Moderating Role of Gender and Perceived Crowding.

This study is aimed to identify the relative (direct) effect of online review ratings and perceived crowding on purchase intentions of a consumer. Our study also investigated the contingent effect of gender and perceived crowding between the relationship of exogenous and endogenous variables. This study was conducted in the Malaysian restaurant industry. We applied the purposive sampling technique to identify respondents, the mall intercept survey method was used for data collection. Smart PLS software was applied for data analysis (200 respondents). This study demonstrates through its results that online review ratings and perceived crowding have a positive effect on purchase intentions of a consumer. Moreover, if a consumer perceives crowding at a restaurant, this has a positive contingent effect on the relationship between review ratings and purchase intentions. This demonstrates that the consumer is more inclined to choose a restaurant with a high online review rating and has high perceived crowding at some unfamiliar place. Lastly, no evidence is found for the gender difference between review rating and purchase intentions; however, gender shows contingent effect and results confirmed that males preferred more crowded restaurants as compared to females. There are theoretical and practical implications for managers in the findings of this study.

3Ts of low cure rate: taxonomy, themes and theory of low cure rate in Pakistan's TB control programme and gathering a 360-degree perspective through qualitative, in-depth interviewing approach.

OBJECTIVE: WHO recommends cure of tuberculosis (TB) as the best prevention strategy; however, information about factors associated with low cure rate in patients with drug-susceptible TB is limited in Pakistan. Therefore, the purpose of this study was to explore the factors that account for low TB cure rate. METHODOLOGY: The present qualitative study recruited diverse informants through purposive sampling to explore low cure rate situation in Badin between March and June 2017. Data were collected from clinicians, paramedics, lab technicians, district field supervisors, patients and treatment supporters through indepth and face-to-face interviews. Interviews were conducted in local languages (Urdu and Sindhi) and transcribed into English. Coding structure was developed inductively and applied on textual data to draw output at the levels of taxonomy, themes and theory, as proposed by Bradley et al. FINDINGS: Thirty-seven individuals consented to participate in this study and provided detailed account of the subject under enquiry. Review of interview data collected from a variety of informants resulted in the identification of four broad factors (taxonomy) that contributed to the situation of low cure rate in one of the districts implementing the public-private mix intervention. These factors were (1) health-seeking behaviour, (2) technical capacity of the healthcare provider, (3) managerial capacity of the healthcare provider, and (4) access to healthcare facility and services. Each factor is deconstructed into key dimensions (themes) that emerged from the dialogue between the interviewer and the respondents. Moreover, dimensions were exemplified through underlying concepts that correspond to theories for low cure rate. CONCLUSION: Change in programme reporting requirement has demeaned the significance of having cure as treatment outcome. Therefore, returning the focus to achieving cure status for TB cases will be beneficial for assessing the effectiveness of TB control efforts. In parallel to the care delivery system, a mechanism for disseminating disease-related and treatment-related information should be introduced.

Farmers' use of mobile phone for accessing agricultural information in Pakistan: / Papel do celular para entrega de informações agrícolas em um distrito carente da

ABSTRACT: Agriculture is considered as the main driving force in Pakistan's economy employing 45% of the country's labor force and generating 20% of national GDP Agriculture sector of Pakistan is facing numerous challenges including non-adoption of agricultural technology at the farm level, due to farmers' lack of access to the latest information. In this context, the current study focusses on the use of the mobile phone in accessing agricultural information among the farmers of the of district Muzaffargarh,Punjab, Pakistan. A multistage sampling technique was used to collect data from the two tehsils (cities/sub-districts) of Muzaffargarh formulating a total sample of 180 farmers. SPSS computer-based Software was used for analyzing the data. Results revealed that 91.2% of the farmers indicated mobile phone ownership. It was further reported that 87.20 % of the farmers used private sectors advisory staff to obtain agriculture information. Market information was ranked as the highest accessed information among the rest of farm-related use. Easy access to updated information and connectivity with stakeholders were reported as the highest perceived benefits of mobile phone use (4.63 & 4.72 mean). Findings reported that farmers' limited aptitude of Mobile phone usage and lack of awareness of information sources as major constraints in farm-related use of the Mobile phone. On the basis of findings, the current study provided recommendations and policy implications for utilizing the true potential of these ICT-enabled solutions in agriculture.

RESUMO: A agricultura é considerada como a principal força motriz na economia do Paquistão, empregando 45% da força de trabalho do país e gerando 20% do PIB nacional. O setor agrícola dos paquistaneses enfrenta inúmeros desafios, incluindo a não-adaptação da tecnologia agrícola entre os agricultores, devido a falta de acesso dos agricultores às informações agrícolas mais recentes. Neste contexto, o estudo atual enfoca o papel do telefone celular na disseminação de informações agrícolas entre os agricultores do distrito Muzaffargarhof Punjab, Paquistão. Uma técnica de amostragem em múltiplos estágios foi usada para coletar dados dos dois tehsils (cidades / sub-distritos) de Muzaffargarh, formulando uma amostra total de 180 agricultores. O software baseado em computador SPSS foi usado para analisar os dados. Os resultados mostraram que 91,2% dos agricultores tinham propriedade de telefones celulares. Verificou-se ainda que 87,20% dos agricultores contatam o pessoal consultivo do setor privado para obter informações sobre a agricultura. As informações de mercado foram classificadas como as mais acessadas entre os demais usos relacionados à fazenda (média de 41,45). O acesso fácil a informações atualizadas e a conectividade com as partes interessadas são relatados como os maiores benefícios percebidos do uso de telefones celulares entre os agricultores com valores médios de 4,63. e 4,72, respectivamente. Os resultados relataram que a capacidade limitada dos agricultores de usar o telefone celular e a falta de conhecimento das fontes de informação como principais restrições ao uso do telefone celular relacionado à fazenda. Com base nos resultados, recomenda-se a realização de sessões de treinamento com as comunidades agrícolas para criar conscientização e educá-las sobre o uso do telefone celular.

Socio-economic determinants of the awareness and adoption of citrus production practices in Pakistan / Determinantes socioeconômicos da conscientização e adoção de práticas de produção de citros no Paquistão

Citrus is the leading fruit of Pakistan and famous worldwide especially kinnow cultivar because of its pleasant taste and remarkable quality. The yield of citrus per hectare in Pakistan is almost half of potential due to non-adoption of recommended horticultural practices by citrus growers. Adopting a decision regarding the improvement of practices is usually influenced by various factors including farmers' socio-economic attributes. In order to determine the relationship between socio-economic aspects and the awareness and adoption of recommended citrus production practices the present study was carried out in Sargodha district from central Punjab, Pakistan. The Study was based upon cross sectional survey research design due to availability of sampling frame, probability (random sampling) was applied for sample selection. Through random sampling, 120 citrus growers were selected as sample. Structured questionnaire administered through interview was used as a research instrument. Analysis of the data collected from the targeted citrus growers revealed a highly significant influence of education on awareness and adoption. Moreover, significant association was found between citrus cultivation area and awareness and adoption of improved practices. Age also showed significant association with awareness and adoption. Moreover, dominancy of middle aged farmers and illiteracyin the study area strongly point the need of provision of formal and non-formal education and training program for farmers. Young generation needs to be focused and reorientation of youth clubs may help in better way to gain the utmost outcome.

Citrus é fruto líder do Paquistão e famoso no mundo inteiro, especialmente Kinnow, cultivado por causa do sabor agradável e de qualidade notável. Por hectare, o rendimento de citrus no Paquistão é quase metade do potencial, devido à não-adoção de práticas de horticultura recomendadas por citricultores. A adoção da decisão sobre práticas melhoradas geralmente é influenciada por vários fatores, incluindo atributos socioeconômicos dos agricultores. A fim de determinar a relação entre os aspectos socioeconômicos e a consciência e adoção de práticas de produção de citros recomendadas presentes, este estudo foi realizado no distrito de Sargodha do centro de Punjab, Paquistão. O estudo foi baseado em projeto de pesquisa do estudo transversal e, devido à disponibilidade de amostragem, amostragem quadro probabilidade (amostragem aleatória) foi aplicada para a seleção da amostra. Por meio de amostragem aleatória, 120 citricultores foram selecionados como amostra. Questionário estruturado, aplicado por meio de entrevista, foi utilizado como um instrumento de pesquisa. A análise dos dados coletados dos citricultores direcionados revelou uma influência altamente significativa da educação sobre a conscientização e adoção. Além disso, foi encontrada associação significativa entre a área de cultivo de citrinos e conscientização e adoção de práticas melhoradas. A idade dos produtores também mostrou associação significativa com a conscientização e adoção. Além disso, a dominância dos agricultores de meia idade e a falta de conhecimento na área de estudo apontam fortemente para a necessidade de oferta de educação formal e não-formal e de formação para os agricultores. Necessidades de geração de jovens a ser focado e reorientação dos clubes de jovens pode contribuir para melhor maneira de ganhar o máximo resultado.

Frequency and determinants of intracranial atherosclerotic stroke in urban Pakistan.

BACKGROUND: Intracranial atherosclerosis (ICAD) is a frequent underlying mechanism of ischemic stroke. There is little direct evidence on its frequency and determinants from regions of high prevalence. This study explores the conventional and socioeconomic risk factors of ICAD in a South Asian population. METHODS: The Karachi Intracranial Stenosis Study is a case-control study of 313 cases of ischemic stroke secondary to ICAD and 331 controls enrolled from 4 major hospitals in Karachi, Pakistan. Stroke subtype was verified by a vascular neurologist using the Trial of Org 10172 in Acute Stroke Treatment classification. Relationships of conventional and socioeconomic risk factors with ICAD-related strokes are reported by calculating odds ratios (ORs) and their 95% confidence intervals (CIs). RESULTS: ICAD was the cause of stroke in 81.1% cases with large-artery atherosclerosis and 19.5% of all stroke events. Along with risk factors like history of hypertension (OR, 3.33; CI, 2.31-4.78), history of diabetes (OR, 2.29; CI, 1.56-3.35), use of tobacco (OR, 1.49; CI, 1.03-2.16), waist-to-hip ratio (OR, 1.58; CI, 1.04-2.41), and family history of stroke (OR, 1.89; CI, 1.21-2.95), other significant social determinants of ICAD strokes were monthly income (OR, 1.59; CI, 1.01-2.51), unemployment (OR, 2.15; CI, 1.21-3.83), and chronic stress (OR, 3.67; CI, 2.13-6.34). These social determinants were independent predictors of the risk of ICAD, in addition to those described in other world populations. CONCLUSIONS: ICAD accounted for one fifth of all strokes making it the most common ischemic stroke mechanism. In addition to aggressive risk factor control, data also indicated broader holistic efforts on ameliorating inequity, unemployment, and stress reduction to reduce stroke because of ICAD.

Stroke radiology and distinguishing characteristics of intracranial atherosclerotic disease in native South Asian Pakistanis.

BACKGROUND: There are no descriptions of stroke mechanisms from intracranial atherosclerotic disease in native South Asian Pakistanis. METHODS: Men and women aged ≥ 18 years with acute stroke presenting to four tertiary care hospitals in Karachi, Pakistan were screened using magnetic resonance angiography/transcranial Doppler scans. Trial of ORG 10172 in Acute Stroke Treatment criteria were applied to identify strokes from intracranial atherosclerotic disease. RESULTS: We studied 245 patients with acute stroke due to intracranial atherosclerotic disease. Two hundred thirty scans were reviewed. Also, 206/230 (89.0%) showed acute ischaemia. The most frequent presentation was with cortically based strokes in 42.2% (87/206) followed by border-zone infarcts (52/206, 25.2%). Increasing degrees of stenosis correlated with the development of both cortical and border-zone strokes (P = 0.002). Important associated findings were frequent atrophy (166/230, 72.2%), silent brain infarcts (66/230, 28%) and a marked lack of severe leukoaraiosis identified in only 68/230 (29.6%). A total of 1870 arteries were studied individually. Middle cerebral artery was the symptomatic stroke vessel in half, presenting with complete occlusion in 66%. Evidence of biological disease, symptomatic or asymptomatic was identified in 753 (40.2%) vessels of which 543 (72%) were significantly (>50%) stenosed at presentation. CONCLUSION: Intracranial atherosclerotic disease is a diffuse process in Pakistani south Asians, with involvement of multiple vessels in addition to the symptomatic vessel. The middle cerebral artery is the most frequent symptomatic vessel presenting with cortical embolic infarcts. There is a relative lack of leukoaraiosis. Concomitant atrophy, silent brain infarcts and recent ischaemia in the symptomatic territory are all frequently associated findings.

In vivo dosimetry with diodes in a radiotherapy department in Pakistan.

The International Commission of Radiological Units (ICRU) sets a tolerance of ±5 % on dose delivery, with more recent data limiting the overall tolerances to ±3 %. One of the best methods for accurate dose delivery and quality check is in vivo dosimetry, while radiotherapy is performed. The present study was carried out to test the applicability of diodes for performing in vivo entrance dose measurements in external photon beam radiotherapy for pelvic tumours and its implementation as quality assurance tool in radiotherapy. During November 2007 to December 2009, in 300 patients who received pelvic radiotherapy on a multileaf-collimator-assisted linear accelerator, the central axis dose was measured by in vivo dosimetry by p-Si diodes. Entrance dose measurements were taken by diodes and were compared with the prescribed dose. Totally 1000 calculations were performed. The mean and standard deviation between measured and prescribed dose was 1.26 ± 2.8 %. In 938 measurements (93.8 %), the deviation was <5 % (1.36 ± 2.9%); in 62 measurements (6.2 %) the mean deviation was >5 % (5.51 ± 2.3 %). Larger variations were seen in lateral and oblique fields more than anteroposterior fields. For larger deviations, patients and diode positional errors were found to be the common factors alone or in combination with other factors. After additional corrections, repeated measurements were achieved within tolerance levels. This study showed that diode-detector-based in vivo dosimetry was simple, cost-effective, provides quick results and can serve as a useful quality assurance tool in radiotherapy. The data acquired in the present study can be used for evaluating output calibration of therapy machine, precision of calculations, effectiveness of treatment plan and patient setup.

Experience of thymectomy by median sternotomy in patients with myasthenia gravis.

OBJECTIVE: To determine the outcome of thymectomy in patients with myasthenia gravis and safety of median sternotomy approach. METHODOLOGY: An observational descriptive study was conducted in the department of thoracic surgery JPMC from February 2005 to January 2009. Twenty-two patients having persistent generalized or ocular myasthenia gravis referred to our department by neurologists and general physicians, partially or not responding to medical treatment with or without thymoma, were included in the study. Those who were not fit for anaesthesia were excluded. Preoperatively 2 to 3 sessions of plasmapheresis were done and each patient was given anti myasthenia gravis treatment. Clinical staging was done by Modified Osserman classification. Median sternotomy approach was used. Outcome was assessed on the basis of remission of disease in different Osserman groups. All patients were followed for a minimum of 6 months. RESULTS: Out of 22 patients, 16 (72.7%) were females and 6 (27.2%) males. Mean age at presentation was 35.2 +/- 14.5 years. Mean duration of symptoms was 1.5 +/- 1.2 years. A total of 4 (18.1%) patients with myasthenia gravis had thymoma and histopathology of 18 (81.9%) patients showed thymic hyperplasia. Remission was seen in most grades of Osserman. The best response was seen in Grade I where all patients achieved remission. Most patients in Grade II A and II B were benefited. The only patient in Grade III had no improvement of symptoms. No patient in Grade IV underwent thymectomy. Overall 86.3% had a positive outcome on basis of remission and improvement. CONCLUSION: Thymectomy by median sternotomy is safe and effective with more favourable outcomes for patients of myasthenia gravis not responding to medical treatment.