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Developing an inclusive policy agenda for ensuring sustainable development is a challenge for both developed and developing countries. The developing countries face challenges in designing policy that achieves sustainable development goals based on environmental awareness, and that is one of the main contributions of this research. By taking into account the SDG 13 (climate action) and 7 (clean and affordable energy) this study examines the influence of education, natural resource availability, financial development, urbanization, and economic growth for ASEAN nations from 1991 to 2018. For an empirical estimate, second-generation approaches are used. The findings demonstrate the energizing influence of renewable energy usage in altering the environmental quality. According to the empirical findings, renewable energy and education lower CO2 emissions by 0.46% and 0.22%, respectively. Financial development, urbanization, and natural resource depletion all have a 0.14%, 0.03%, and 0.08% impact on the environment, respectively. The heterogeneous causality analysis reveals the feedback effect, i.e., bidirectional causal links between education, carbon emissions, and the use of renewable energy. This empirical data implies that nations should enhance investment in renewable energy and education sectors, as well as prepare for renewable energy research and development, to ensure environmental sustainability. This research has policy implications for ASEAN countries in terms of renewable energy and education investments. Through this agenda, the objectives of SDG 13 and SDG 7 will be achieved, while SDG 4 will be targeted. [ABSTRACT FROM AUTHOR]

Objective: To compare the effectiveness of two types of haemostatic sutures to secure bleeding in thinned out caesarean section scars. Study Design: Comparative Interventional Study. Setting: CMH Okara, Pakistan. Period: September 2019 to September 2021. Material & Methods: Patients were divided in four categories. Category I was previous one scar patients while category II was previous two scars patients. Similarly, categories III and IV were previous three and four scar patients respectively. In each category hemostasis was secured either by purse string suture or transverse mattress sutures. Hemostasis whether achieved with difficultly or without difficulty was assessed and time utilized was also calculated. Results: In patients with previous one caesarean section 3 out of 15 (20%) had haemostatic difficulty with both purse string suture and horizontal mattress suture. In patients with previous two caesarean sections the number was 5 (33.33%) and 6 (40%) in both purse string and horizontal mattress suture respectively. In patients with previous three caesarean sections there were 7 (46.66%) women who had difficulty in haemostasis in both group I and II. The average time to achieve the procedure in group I (purse string suture) was 3.25 minutes while it was 7.5 minutes in group II (Horizontal mattress sutures). There was two times difference in time consumption between two groups. Conclusion: Purse string suture is more effective, convenient and quicker to apply as compared to transverse mattress sutures for haemostasis in thinned caesarean section scars. [ABSTRACT FROM AUTHOR]

Background: There were many studies reported deficient vitamin D in patients with inflammatory bowel disease. Objective: Our study aimed to examine the relationship between vitamin D levels and clinical disease activity in patients with inflammatory bowel disease (IBD). Patients and Methods: A prospective study was conducted at IBD Outpatient Clinic of Al-Rajhi University Hospital of Assiut University Hospitals in period from May 2018 to May 2019. The study enrolled 54 patients with known IBD. In addition to reviewing the demographic and clinical data, serum vitamin D was measured in all patients. Results: Mean age of enrolled patients was 34.24 ± 11.71 years with range between (14 - 67) years. Females were more than half of participants (51%). Mean serum vitamin D level was 43.45 ± 33.91 ng/ml. 20 IBD patients (37%) were deficient in vitamin D, 4 (7.4%) patients had insufficient level and 30 (55.6%) patients had normal level. Patients with deficient vitamin D had significantly higher C-reactive protein in comparison with those with insufficient level and those with normal level. Patients on conventional therapy or biological therapy had insignificant differences as regard level of vitamin D and its status (P> 0.05). There is a non-significant differences as regard level of vitamin D and disease activity, but the level of vitamin D were lower in active patient than non-active one. Conclusion: Vitamin D insufficiency was uncommon among IBD patients, especially in those with Crohn's disease, and was linked to a stronger inflammatory response as well as more active illness. [ABSTRACT FROM AUTHOR]

Modernization refers to the general process of progress within human societies. As a result of carbon dioxide emissions, global warming poses a significant threat to human sustainability. Therefore, the scientific community must thoroughly research the impact of modernization on CO2 emissions. Surprisingly, just a few pieces of research have previously examined this subject. Asian economies are regarded as laggards in achieving the Sustainable Development Goals (SDGs), with environmental degradation being one of the key issues confronting these countries. This study used panel data regression to investigate the association between sectoral modernization and CO2 emissions in South Asia. None of the existing studies has observed the sectoral modernization and CO2 emission nexus in the region of South Asia. Therefore, this study bridges the research gap in the current literature. This study found that social sector transformation, energy sector, and services sector modernization have negative associations with CO2 emissions in South Asia. However, both the agricultural sector and industrial sector modernization are positively associated with CO2 emissions in South Asia. The empirical results from several models suggest that sectorial modernization has a significant and strong association with environmental sustainability. Access to a green and eco-friendly economy can increase modernization among different sectors of the economy to produce pro-environment products and society. Also, we found that FDI and trade policies influence the economies to follow environment-friendly economic practices. [ABSTRACT FROM AUTHOR]

Objective: To find the appropriate timings for intervention in women with intrahepatic cholestasis of pregnancy. Study Design: Prospective observational study. Place and Duration of Study: Gynaecology and Obstetrics Department Combined Military Hospital Okara, from Oct 2019 to Nov 2020. Methodology: Patients between 34-40 weeks of gestation with intrahepatic cholestasis were included in the study. With clinical and biochemical findings patients were monitored and conventional treatment was given. Intervention by delivery was done when required. Maternal and fetal outcome were followed. Results: Out of 380 patients with pruritus between 34-40 weeks of gestation, intrahepatic cholestasis was found in 53 patients. Most of the patients 27 (51%) were delivered at 37-completed weeks. At 35-weeks of gestation 6 (11%) patients were delivered, at 36-weeks 8 (15%) patients were delivered, while 2% patients delivered at 39 and 40 weeks of gestation. The number of intrauterine deaths was 1 at 34 weeks of gestation and 2 at 35 weeks of gestation. Transient tachypnea of newborn was observed in 23% neonates. Respiratory Distress Syndrome was observed in 6 (12%) newborns. Neonatal sepsis was observed in 5 and hyperbilirubinaemia was observed in 4 (8%) neonates. Conclusion: Patients with intrahepatic cholestasis should be preferably delivered between 37 to 38 weeks for a better foetal outcome. [ABSTRACT FROM AUTHOR]

Objective: To see the efficacy of the gynecological procedure of outdoor endometrial biopsy using pipelle biopsy. Study Design: Prospective observational study. Place and Duration of Study: Sampling was done at obstetrics and gynecology department Pak-Emirates Military Hospital Rawalpindi, from Jan 2018 to Aug 2018. Methodology: A 100 cases of perimenopausal/postmenopausal women presenting with menorrhagia/menorrhagia after the age of 40 years were selected for the study. Pipelle biopsy was employed in all the cases. Results: The patients presenting with metorrhagia, menorrhagia, polymennorrhagia and postmenopausal bleeding with mean age of 46 ± 3.26 were included in the study. Sixty eight (68%) patients had metorrhagia, 10 (10%) presented with menorrhagia, 10 (10%) patients had polymennorrhagia while 12 (12%) patients had postmenopausal bleeding. Histopathological results showed that 5 (5%) patients were suffering from chronic endometriosis, 20 (20%) had hormonal imbalances, 45 (45%) had proliferative endometrium, 18 (18%) had endo-metrial benign hyperplasia. Conclusion: It is concluded that outdoor endometrial conventional biopsy using pipelle biopsyis cost-effective and convenient method for diagnosing endometrial diseases. The procedure while providing reliable histopathological results in all cases is cheap and causes minimal discomfort to patients. [ABSTRACT FROM AUTHOR]

\Objective: To gain insight about the perception of female subjects on COVID-19. Study Design: Cross-sectional study. Place and Duration of Study: Gynaecology department of Pak Emirates Military Hospital, Rawalpindi, from Mar to Jun 2020. Methodology: The data obtained from a questionnaire filled by a total of 205 female participants with mean age of 31.84 ± 8.52 years, visiting the Gynaecology outdoor patient department was used. The data was analyzed and descriptive analysis was made in percentages. Results: Electronic media (TV/Radio) was the main source of information about COVID-19 for 170 (83%) of the participants. Most of the participants identified that the main symptoms of COVID were flu 115 (56%), cough 104 (51%) and fever 109 (53%). About the protective and hygienic measures, 125 (61%) chose hand washing for twenty seconds while 116 (57%) of the participants chose wearing masks and 87 (42%) opted for maintaining the distance from an infected individual. One hundred (49%) of the total participants believed that the transmission of the virus to infants takes place via breast milk of nursing females while 147 (72%) of the females responded negatively for the breastfeeding to be responsible for the transmission of the virus. One hundred and thirty females (73%) believed that this disease was completely curable while 55 (27%) of females responded that a complete cure was not possible. Conclusion: Most of the females have generally satisfactory information about the signs and symptoms of the novel virus and the commonly employed precautions against the disease. [ABSTRACT FROM AUTHOR]

Objective: To determine the autonomy of young Pakistani women in house hold decision making and the use of modern contraception; and to find association between couples’ joint participation in decision making and use of modern contraception. Study Design: Cross-sectional study. Place and Duration of Study: Pak Emirates Military Hospital, Rawalpindi, from Aug 2018 to Aug 2019. Methodology: The study took place at Gynae & Obstetrics department Pak Emirates Military Hospital, Rawalpindi from Aug 2018 to Aug 2019. Cross-sectional study design was adopted. Results: Out of 360 women, 179 (49.7%) had 3-5 children while only 17 (4.7%) had more than 6 children. According to 261 (72.5%) women both husband and wife wanted same number of children while in only 2 (0.6%) cases husband wanted fewer children. Socioeconomic status showed a statistically strong association (p=0.035) with using modern contraceptives. Education status showed a statistically strong association with desire for more children (p=0.004), usage of modern contraceptives (p=0.004) and respondents role in household decision making (p=0.041). Conclusion: It was found that in substantial number of couples decision for usage of modern contraceptives was mutual. A very alarming finding was that most of the women have not had an encounter with family planning worker in last six months despite the fact that most of the women in the study did not have desire to have more children. [ABSTRACT FROM AUTHOR]

Objective: To determine the frequency of gestational diabetes mellitus in pregnant patients having increased serum uric acid level in first trimester of pregnancy. Study Design: Descriptive case series study. Place and Duration of Study: This study was conducted at Pak Emirates Military Hospital Rawalpindi for a period of 6 month, from Jul 2015 to Jan 2016. Material and Methods: All 140 pregnant women in their first trimester with increased serum uric acid level (cut off value >4mg/dl) were included in the study according to inclusion criteria (antenatal women with gestational amenorrhea of less than 13 weeks, age 20 to 40 year, parity 0 to 8) and exclusion criteria (pregestational diabetes, hypertension, renal disease, liver disease, multiple gestations, gout, drugs which increases uric acid excretion, past history of gestational diabetes mellitus, history of good size baby in previous pregnancies). Sampled patients were followed up in OPD, at 24 weeks of gestation, 75g OGTT was performed to diagnose GDM with cut off value: fasting blood sugar level of >92 mg/dl, 1 hour after breakfast >180mg/dl, 2 hours after breakfast >155mg/ dl. Sampling technique was no probability consecutive sampling. Results: Frequency and percentage was observed for two groups (presence or absence) of gestational diabetes mellitus (GDM). Eighty one patients (57.9%) had positive (yes) gestational diabetes mellitus, while remaining 59 patients (42.1%) had Negative (no) gestational diabetes mellitus. Gestational diabetes mellitus has the prevalence rate between 50-51% among population with high serum uric acid. To determine the frequency of GDM in the population having high serum uric level, we applied one sample t test (one sided test). The hypothesis of our one sample test was H0: P≤P0, H1: P>P0 where p0 was anticipated population proportion. We find that the prevalence rate of GDM in the population having high serum uric acid is between 50-51%. Conclusion: It is suggested that levels of uric acids in serum must be monitored routinely during first antenatal care visit. Uric acid levels in serum should be monitored routinely during the first antenatal care visit. Frequency of GDM is also linked with higher number of parity. [ABSTRACT FROM AUTHOR]

Objective: To study the efficacy of superior hypogastric block as a method of pain relief for abdominal hysterectomy performed under spinal anaesthesia for benign indications. Study Design: A randomized, double blind, placebo-controlled, clinical trial. Place and Duration of Study: Military Hospital Rawalpindi Pakistan, from Jan 2017 to Sep 2017. Population: Sixty-two women scheduled for total abdominal hysterectomy for a benign indication. Material and Methods: We carried out a double blind randomized placebo controlled trial on 62 patients from January 2017 to September 2017. Patients were randomly grouped into group A (RG) where 20 ml of ropivacaine 0.25% was used and group B (SG) where 20 ml saline was used. Opioid analgesia in the form of nalbuphine was used in all the patients as per requirement and patients were followed for 12 hours. Patients, staff and assessors were blinded to group assignment. Superior hypogastric plexus block performed during abdominal hysterectomy lowers opioid consumption postoperatively. Main outcome measures: Primary outcome measures included amount of opioid consumption and visual analogue score (VAS) for pain. Secondary endpoints were the requirement of backing up opioid with diclofenac and presence of opioid related side effects like sedation, vomiting and itching Results: The study was performed with 31 women randomized each to ropivacaine and saline group. Analysis was performed on 31 women in the ropivacaine group and 30 women in the saline group. The postoperative opioid consumption was significantly lower in the ropivacaine group than in the placebo group (median 3.13 and 3.80, respectively, p=0.01). Similarly, median VAS score was significantly less in ropivacaine group (3.4 in ropivacaine group compared to 4.7 in saline group with p<0.01). No side effects or important adverse events occurred during the study. Conclusion: The superior hypogastric plexus block was found an effective new tool to manage postoperative pain after abdominal hysterectomy. It can be considered as a part of multi modal analgesia technique. [ABSTRACT FROM AUTHOR]

Objective: The present study was designed to study the role of antenatal check upon caesarean section (C-Section) rate in patients reporting to labour room. Study Design: Prospective cohort study. Place and Duration of Study: The study was carried out at Combined Military Hospital (CMH) Attock, from Oct 2014 to Mar 2015. Material and Methods: A total of 447 patients who underwent treatment in CMH Attock were included in this study. Patients were divided into two groups: 1) Booked patients - the ones who consulted obstetrician regularly during pregnancy, 2) Unbooked patients - These patients do not consult obstetrician for ante-natal checkup during the pregnancy. The data was collected on a proforma and was statistically analyzed. Results: About 77.85% of the total recruited patients in the study were booked while 22.15% were un-booked. A 37.6% of the booked patients had to undergo caesarian section (c-section) while 62.4% patient underwent spontaneous vaginal delivery (SVD). Whereas 51.5% un-booked patients had c-section while 48.5% patients underwent SVD. Point two percent and 2.5% of the overall patients had gestational diabetes and anaemia respectively. Three percent of the total pregnant patients were diagnosed as being hypertensive. Patient history revealed that 3% patients had bad obstetrics history and 76.9% of them attended ante-natal clinic. Conclusion: In our set up overall C-section rate was 42.6% but in the booked group the rate was 37.6% as compared to the much higher 51.5% in the un-booked group thus indicating that high C-section rate in the unbooked group contributed in a major way to the overall C-section rate. [ABSTRACT FROM AUTHOR]

Objective: To determine the diagnostic accuracy of Magnetic Resonance Imaging (MRI) and ultrasonography to detect adenomyosis, keeping histopathology as the gold standard. Study Design: Cross-sectional study. Place and Duration of Study: Radiology and Gynecology departments of the Combined Military Hospital, Quetta Pakistan, from Aug 2019 to Aug 2021. Methodology: One hundred sixty-two patients were enrolled in this study after taking written and informed consent. After taking history, all patients were assessed by Magnetic resonance imaging and transvaginal ultrasonography. The magnetic resonance imaging and transvaginal ultrasound findings were noted on a predesigned proforma. All the patients underwent a hysterectomy, and a Biopsy specimen was sent for histological confirmation of adenomyosis. The accuracy of diagnosis was assessed in both initial modalities. Results: A total of 162 patients were enrolled in the study. The mean age of the females and junctional zone diameter (JZmax) in mm on MRI was 38.56 years and 12.54.9 mm. In terms of parity, 32 (19.8%) females were nulliparous, 68 (42%) females had low multi-parity, and 62 (38.2%) females had high multi-parity. On magnetic resonance imaging, adenomyosis was present in 112 (69.1%) females. On transvaginal ultrasound, it was present in 97 (59.9%) females, and on histopathology, it was present in 105 (64.8%) females, out of which 36 (34%) had diffuse adenomyosis and 32 (30.8%) had focal adenomyosis. The sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of Magnetic resonance imaging was 86.7%, 36.9%, 81.3%, 71.8% and 78.4% respectively and of transvaginal ultrasound it was 65.7%, 50.9%, 71.1%, 44.6% and 60.5% respectively. Conclusion: Magnetic resonance imaging has superior diagnostic accuracy for adenomyosis than transvaginal ultrasound. [ABSTRACT FROM AUTHOR]

Objective: To share clinicopathological spectrum of hysterectomies performed at CMH Rawalpindi. Study Design: A cross sectional descriptive study. Place and duration of the study: This study was carried out at Obstetrics and Gynaecology department CMH Rawalpindi, from October 2010 to June 2012. Material and Methods: Total of 54 patients who underwent hysterectomy were selected for the study. Detailed history and examination of the patient pre and post-operatively were carried out to observe the indications and complications of hysterectomy. Results: In total 54 hysterectomies were carried out; all of which with the exception of one were total abdominal. The patients who underwent hysterectomies were in the 4th decade of life. The most common (48%) indication of hysterectomy in our study was found to be menstrual irregularities like menorrhagia, irregular vaginal bleeding, DUB and post-menopausal bleeding give frequently of complication as well. Delayed wound healing was the most common complaint (7%). Histopathology carried out on the uterine specimen showed adenomyosis 17(31%) being the most common finding. Conclusion: Abdominal hysterectomies carried out in our setup are most commonly done for menstrual irregularities and complication rate is low. [ABSTRACT FROM AUTHOR]