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Climate change and rapid socioeconomic development have exacerbated the damage caused by hydrological droughts. To ensure effective drought defense and infrastructure development, it is essential to investigate variations in hydrological droughts. The primary objective of this study is to reconstruct the natural streamflow by using Soil and Water Assessment Tool (SWAT) hydrological modeling. The hydrological drought at different time scales (1, 3, 6, and 12 months) were measured using the streamflow drought index (SDI). The statistical parameters, including Nash–Sutcliffe Efficiency and the Coefficient of Determination, which yielded values of 0.84 and 0.82 during the calibration period and 0.78 and 0.76 during the validation period, respectively, showed a satisfactory SWAT model performance. Additionally, the Pettit test was used to identify a change point in streamflow within the 1991–2015 timeframe, leading to the division of the study period into two distinct phases: an undisturbed period (1991–1998) and a disturbed period (1999–2015). The SDI index‐based analysis revealed 9.39% moderate drought and 3.13% severe drought during the undisturbed period, while 11.76% moderate drought and 7.35% severe drought may happen due to the human influences that occurred in the disturbed period. These findings enhance the understanding of the hydrological drought variations in the Soan River basin for optimizing the water resources management system and effectively preventing and mitigating drought‐related damages. [ABSTRACT FROM AUTHOR]

The purpose of this research is to investigate relationship between stress at work and amount of job satisfaction experienced by surgeons, while taking into consideration moderating effects of social support. First of two aspects of occupational stress that are investigated is the failure to maintain a healthy balance between one's personal and professional lives. Second is stress that is experienced while working. To collect primary data, questionnaire was sent to 500 medical professionals, the majority of whom were surgeons employed by private institutions. Results of this research demonstrated that a healthy work-life balance has a significant impact on the job satisfaction. Moreover, lower levels of job satisfaction have been connected to workplace stress. The unfavorable association between work-life balance and job satisfaction is minimized when surgeons have access to social services. Also, it reduces the detrimental impact of work-related stress on performance, that is significant advantage. Top-level managers have potential to boost surgeons' satisfaction by implementing stress management practices in the workplace and offering social support. [ABSTRACT FROM AUTHOR]

The major objective of current research is to investigate the role of spiritual leadership and inclusion practices on workplace spirituality. The sample size of study consisted of manufacturing companies operating in selected cities of Pakistan. Sample selected for this study was 300 which was selected based on previous literature. 300 questionnaires were distributed among managers at a diverse levels of manufacturing companies. Research used probability-based, simple random selection plan to choose participants for questionnaire completion. The results suggested that spiritual leadership had a significant effect upon workplace spirituality. Results suggested that inclusion practices have significant effect on workplace spirituality. Study is vital for managers and companies' policy makers to make policies by using study findings to boost productivity of employees. This research is restricted to examining how performance of MNC's industry is affected by influence of just a few aspects of leadership. Comparison of influence of leadership in MNC's and small and medium-sized enterprises would provide a new perspective to the study of literature and leadership. [ABSTRACT FROM AUTHOR]

Objective: Several biomarkers like NGAL, KIM-1, IL-18, and Cystatin C has been previously reported as reliable marker to predict AKI. However, their predictive accuracy varies widely. We aim to observe the efficacy of multiple markers, NGAL, KIM-1, Cystatin C and IL-18, in obstetric population who are at risk of developing AKI. Methods: This prospective study was carried out between June 2021 to March 2022 at Department of Obstetrics & Gynecology Unit II, Ruth Pfau KM Civil Hospital and Sindh Institute of Urology & Transplant (SIUT), Karachi Pakistan. On women brought to OBGYN-ER with the diagnosis of hemorrhage (antepartum and postpartum), hypertension (preeclampsia and eclampsia) and sepsis. The urine samples and 3cc blood was collected at the time of admission, blood sample processed for biochemistry at time of admission and repeat blood samples for serum creatinine at 24 and 48 hours. Urine was stored at -80ºC and later evaluated for NGAL, KIM-1, Cystatin C and IL-18. Serum Cystatin C was also processed for the time zero sample. The biomarkers were tested using ELISA assays. Results: A total of 149 women were included in the study, 83% of these women were non-booked. Twenty-six (17%) women developed AKI. Serum Cystatin C, urinary Cystatin C and urinary NGAL were found significantly raised in women who developed AKI. While KIM-1 and IL-18 were not raised to statistical significance in this population. However, urinary KIM-1 along with urinary Cystatin C were significantly raised in women with positive quick sequential organ failure assessment (qSOFA). Conclusion: This study validates the use of serum and urinary Cystatin C and urinary NGAL as highly predictable biomarkers for the development of AKI and nullifies urinary IL-18 and KIM-1 in this regard. [ABSTRACT FROM AUTHOR]

Background: Laparoscopic Appendectomy (LA) is no longer a new procedure in pediatric surgery. In many pediatric surgery centers, laparoscopic management of acute appendicitis is practiced but we have observed that most of them performed laparoscopic appendectomy for simple straight forward appendicitis. It is generally considered that complicated appendicitis is better managed by an open procedure. The objective of this study was to establish safety of laparoscopic appendectomy in complicated appendicitis in children. Methods: Research was conducted at the Department of Pediatric Surgery, Shifa International Hospital Islamabad. Duration of study was 3 years after due approval from the ethical and research review board. Medical records of 42 patients who were operated on for complicated appendicitis laparoscopically at Shifa International Hospital, Islamabad from January 2018 to December 2020 was reviewed. All patients were enrolled from the emergency department. Clinical assessment of the patients was done in a routine way by history and physical examination. Investigations included complete blood count, C reactive protein and ultrasound abdomen and pelvis. Patients who had simple uncomplicated appendicitis, who had open appendectomy, and those who had laparotomy for other reasons were excluded from the study. All those patients who had complicated appendicitis like perforation, abscess, mass, or gangrene were included in the study. Variables observed in this study were age, gender, operative findings, operative time, hospital stay and postoperative complications. Results: The mean age of the patients was 9.95 ±3.22 years. Of 42 patients, 32 (76%) patients were male and 10 (24%) were female. Mean operative time was 42.5 ±20.03 minutes. Mean hospital stay was 2.23 ±1.55 days. Out of 42 patients, 20 (48%) had perforated appendicitis, 9 (21%) patients had appendicular mass, 12 (29%) patients had appendicular abscess, and 1 (2%) patient had gangrenous appendicitis. Postoperatively, one patient of perforated appendicitis had trocar site infection. One patient who had appendicular mass developed urinary retention with periorbital puffiness postoperatively. Two patients of appendicular mass had transaction of appendicular base due to perforated and sloughed appendicular base. One patient with an appendicular abscess had a large collection in the right paracolic gutter. One patient of appendicular abscess developed peritonitis with abscess formation secondary to cecal perforation. Conclusion: Laparoscopy for complicated appendicitis is safe in children with only fewer complications. Despite our limited experience of laparoscopic appendectomy, we believe that laparoscopy may safely be done as a first choice in all patients with appendicitis, whether simple or complicated. [ABSTRACT FROM AUTHOR]

Background: Foreign bodies in aero digestive tract is a common emergency in pediatric age group. Methods: This cross-sectional study included 156 patients of foreign bodies in aero digestive tract over a period of 2 years from January 2016 to December 2017. Results: Out of 156 patients, foreign body in esophagus was found in 111 patients with age range from 6 months to 12 years. Fifty-six patients (50%) belonged to 3-5 years age group. Coin was found in most of the patients which constitutes 61(55%) patients. Majority of the foreign bodies got impacted in cricopharynx. Of all the patients, 45 had foreign body in airway with age ranging from 6 months to 12 years. Peanuts were found in majority of cases, constituting 20% and right bronchus was mostly affected. One patient of foreign body ingestion expired. [ABSTRACT FROM AUTHOR]