Search

Percutaneous Gastrostomy (PEG) tube is an endoscopic-guided procedure to provide enteral nutrition, medications and/or fluids to patients with oral or esophageal pathologies. PEG tubes are a relatively safe intervention but commonly known to have complications like insertion site infection, tube leakage, and tube blockage. This was an unusual case in which the PEG tube was discovered to be obstructing the third part of the duodenum after migration resulting in mechanical gastric obstruction with septic shock and severe hemodynamic instability. PEG induced gastric obstruction is often misdiagnosed during a triage due to the atypical presentation of this condition leading to aggressive management, testing and consultations. PEG dependent patients have rapidly increased over the years and a complete physical examination of the PEG site should be performed by all physicians in order to prevent related complications.

The current study aims to examine how and why actors contest the business education field through rankings. Inspired by the field structuration process and field level change, we argue that categorization systems, in this case, rankings, construct boundaries of the business education field and redefine authority and elites for the field. Ten highly ranked Pakistani business schools were selected through a purposive sampling method. For the thematic analysis adopted in the current study, we collected empirical evidence mainly through interviews with the directors of accreditation and ranking bodies, deans, and marketing directors of business schools. The interview data was also supplemented by secondary data such as internal student surveys, business school’s annual reports, and other relevant sources of data. The current study showed institutional work in the business education field. Through categorization systems, actors use their authority to challenge the existing social order and define the uncontested space of the business education field in developing countries. Actors then populate the uncontested space with new members thus legitimizing new rules and standards for the field and promoting new elites for the field thus creating new social order.

The synthesis of silver nanoparticles (AgNPs) by the green method is favored as compared to chemical synthesis due to their appreciable properties of less toxicity and simple synthesis. The current study designed the biosynthesis of AgNPs in one step by using the plant Kickxia elatine (KE) extract and then investigated its inhibiting activity against rat’s brain acetylcholinesterase (AChE) ex vivo. Ultraviolet spectrum at 416 nm confirmed the formation of AgNPs. X-ray diffractometer calculated size was reported to be 42.47 nm. The SEM analysis confirmed spherical-shaped AgNPs. FT-IR suggested that the phytochemical groups present in the KE extract and their nanoparticles (NPs) are responsible for the biosynthesized of NPs. EDX analysis presented that Ag was the chief element with 61.67%. Both KE extract and AgNPs showed significant anti-AChE activity at 175 µg·mL−1. Statistical analysis showed that both KE and AgNPs exhibited non-competitive type inhibition against AChE, i.e. V max decreased (34.17–68.64% and 22.29–62.10%), while K m values remained constant. It is concluded that KE and AgNPs can be considered an inhibitor of rats’ brain AChE. Furthermore, the synthesis of AgNP-based drugs can be used as a cheaper and alternative option against diseases such as Alzheimer’s disease.

IntroductionThe COVID-19 pandemic has led to unprecedented strain to healthcare systems worldwide and posed unique challenges to the healthcare professionals (HCPs) and the general public.ObjectivesThe aim of this study is to evaluate the impact of COVID-19 on the mental health, behavioral, and physical wellbeing of HCPs in the early and mid-term periods of the pandemic in comparison to non-HCPs. Thus, facilitating and guiding optimum planning and delivery of support to HCPs.Methods and AnalysisAn observational cross-sectional survey and cohort study aiming to enroll over 1050 participants (minimum, 800 HCPs and 250 controls). Study questionnaires will be completed at baseline and after 6-weeks and 4-months. Recruitment initiated July 2020. The study was designed in London, United Kingdom, but open to participants worldwide. Baseline: Questionnaires comprising of validated self-administered screening tools for depression, anxiety, sleep-related issues, wellbeing, and burnout. The questionnaires also explore changes in behavior and physical wellbeing of the participants. In addition, associations of these mental health and behavioral factors with work-related factors and support will be explored. Six-weeks and 4-months follow-up: Follow-up questionnaires will assess change in symptoms of anxiety and depression, sleep disorders, use of alcohol and other substances, behavioral or interpersonal relationship changes. Physical wellbeing will be assessed through the presence of suspected or confirmed COVID-19 infection and absence from work. We will also evaluate the impact of variable provision of personal protection equipment (supply and training), extended working hours, and concern for the wellbeing of family members, anxiety levels, and evidence of burnout.Statistical ConsiderationsThe study has 80% power to detect a 10% difference of combined depression and/or anxiety symptoms between the groups using two-sided type 1 error at 0.05 at baseline. Assuming that only 50% of these HCPs agree to be a part of a cohort survey, we will have 80% power to detect around 12% difference in the two groups in reported physical symptoms (20% vs. 32.3%), or prevalence of depression and/or anxiety at the end of the study.EthicsThe study was approved by the Cambridge East, Research Ethics Committee (20/EE/0166).Trial Registration NumberClinicalTrials.gov, NCT04433260.

Abstract This review article aims to present the epidemiology and associated risk factors of allergic rhinitis (AR) in Asia. AR-related literature published on Asia was systematically reviewed and the associated risk factors were investigated. The prevalence of AR in Asia varied considerably depending on the geographical location, study design and population involved. Several risk factors were observed to have strong association with disease presentation across multiple studies. Among these, family income, family size, daily personal computer usage time, personal and parental education attainment, and stress level have shown some level of biological gradient influence when multiple risk levels were analyzed. This suggests that AR manifestation and presentation possibly might be strongly affected by various personal and family factors. These findings are beneficial as they may provide insights into modifiable factors that may influence AR presentation. In addition, these results indicate that strategies to reduce personal and family-related risk factors have to be developed in order to alleviate the odds of AR expression.

Equine ownership is a common income-generating strategy in Pakistan. In Karachi, donkey carts are used to transport building materials, commercial produce and garbage. This study aimed to articulate the role and welfare of donkeys used in waste management. We conducted interviews with donkey owners (n = 200), households which use donkey carts for waste collection (n = 50) and key informants (n = 14). To assess the welfare of donkeys, the Standardised Equine-Based Welfare Assessment Tool (SEBWAT) was used (n = 204). Collection of waste was the primary source of income for 89% of owners interviewed. Of those directly involved in waste collection, 62% were found to be under 18 years of age. During interviews with donkey cart customers the majority reported that there would be a huge garbage build-up if donkey carts were not available. Welfare assessments demonstrated that 52.9% of donkeys had a body condition score of two. Muzzle mutilation was extremely high (78.4%) and 66.7% of donkeys had superficial knee lesions. This is the first study that has explored the role of donkey carts in waste management in Pakistan. The data demonstrate the sizable role that donkey-owning communities play in waste management and the important livelihood option this offers, as well as considerable animal welfare concerns.