Energy consumption, economic growth, and environmental sustainability challenges for Belt and Road countries: a fresh insight from "Chinese Going Global Strategy"

The present study investigated the impact of energy- and economy-related variables on CO2 emissions in 49 countries of the Belt and Road Initiative from 1995-2018. The robust type of cross-section dependence and heterogeneity methods was adopted to analyze data set of countries. Energy consumption, foreign direct investment, medium and high-tech industry, and GDP have been found highly unfavorable for the ecological health (CO2 emissions) in 49 nations on BRI panel. However, renewable energy consumption has been found in positive correlation with environmental quality (CO2). Financial development indicator has no significant impact on CO2 emissions in present study. The present outcomes clearly claim strong relationship of economic growth and energy with increased CO2 emissions in 49 nations. Therefore, it is important for policy makers, experts, and governments to incentivize and appreciate portfolio investors for sustainable green investments to transform the economic growth into a sustainable and energy efficient development.

THE ASSOCIATION OF CATARACT TYPE ON CENTRAL CORNEAL THICKNESS AFTER PHACOEMULSIFICATION CATARACT SURGERY

Objective: To assess any association between the type of cataract and the central corneal thickness at pre-operative and postoperative three-day and one-month appointments after phacoemulsification surgery. Study Design: Prospective, comparative study. Place and Duration of Study: Eye Department Combined Military Hospital Multan, from Jun 2020 to Apr 2021. Methodology: A total of 89 patients requiring cataract surgery by phacoemulsification were recruited. Age and gender were recorded for each patient. Patient’s type of cataract based on maturity was recorded before the surgery. Phacoemulsification cataract surgery using ‘divide and conquer’ technique was carried out. Patients’ central corneal thickness was measured at the pre-operative, three-day post-operative and one-month post-operative appointment using traditional non-contact tonopachymeter. Results: There were 49 (55.1%) male and 40 (44.9%) female patients with a mean age of 62.15 ± 12.40 years. No significant association was found between the type of cataract and central corneal thickness at the three-time intervals (p=0.14). Central corneal thickness significantly increased from 0.48 ± 0.04 mm pre-operatively to 0.51 ± 0.04 mm at the three-day post-operative appointment (p<0.001). It then reduced to 0.49 ± 0.04 mm at the one-month appointment (p=0.01). Conclusion: The type of cataract is not associated with the variation in central corneal thickness due to cataract surgery. Central corneal thickness significantly increases from the pre-operative to right after the cataract surgery. However, it returns to preoperative levels after a one-month period.

1242 A Surfacing Staghorn: Spontaneous Expulsion of a Large Renal Calculus from A Nephrocutaneous Fistula

An 83-year-old lady presented to the urology department with right flank pain in the context of a previously known right renal staghorn calculus. On examination, she was found to have a visible discharging sinus in her right flank, and the renal calculus had become visible at the skin surface. Non-contrast CT imaging confirmed that her staghorn calculus had eroded through the skin via a nephrocutaneous fistula. The stone was manually extracted percutaneously on the ward, and she was treated with intravenous antibiotics. She subsequently passed a further stone through the tract and made a good recovery.

This is a highly unusual presentation of nephrolithiasis in a developed country in the 21st century. Review of the literature suggests that surgical management is almost always indicated in patients with staghorn calculi. However surgical management options are not without risk and conservative management of staghorn disease may be appropriate in select patient groups: those with multiple co-morbidities at high risk for GA, in cases of patient refusal of surgery, or in patients with aberrant anatomical factors

Our case highlights a potential complication of conservatively managed staghorn stone disease. To our knowledge our case is the first of spontaneous expulsion of renal stone of this size to be reported in the developed world.

Traditional knowledge about medicinal plant in the remote areas of Wari Tehsil, Dir Upper, Pakistan

Traditional medicine is cheaper and easily available to local people, to care for most frequent diseases in the Northern parts of Pakistan. Our study aimed at inventorying medicine from local plants, documenting their uses, and assessing their market value in 2015-2018 during spring, summer, and winter seasons. A total of 15 trips were made, 5 in each season. Semi-structured interviews with 165 inhabitant's age range between 20-80 years were conducted, analyzed the data is analyzed using Relative frequency of citation(RFC), Use Value(UV), Fidelity Level(FL), Informants consensus factor(ICF), and Jaccard index(JI) to find the most frequent and well-known used species in the area. A total of 86 species belonging to 39 vascular plant families, 33 genera were documented as medicinally important. Family Asteraceae was observed as the dominant family among all the families with 10 species, the leaf was the most used parts and decoction 36% was the most preferred preparation type. Herb was the predominant life form (67%). The maximum UV (0.92) was demonstrated by J. adhatoda L. species, while A. sativum L. shows maximum RFC (0.58), the highest ICF value represented by diarrhea and dermatitis 0.92, and high FL value is recorded 100%. According to our collections, wild species were 45%, invasive species were 38% and cultivated 17% recorded, dicots species were recorded more 81%. Seven 7 medicinal species is being economically important and export to the local and international market of the world, whereas P. integrima L. species were the most exported species according to the local dealers. The investigated area is rural and the local people depend on the area's plants for their health needs, and other uses like a vegetable, fuelwood, fodder, etc. The current result of RFC, UV, ICF, FL, and JI shows that medicinal flora needs to be pharmacologically and phytochemically investigated to prove their efficacy. The documentation of medicinal knowledge is important to preserve this precious old knowledge before it is lost forever, due to technological and environmental changes in the world.

Asymmetric impact of temperature on COVID-19 spread in India: Evidence from quantile-on-quantile regression approach

The emergence of new coronavirus (SARS-CoV-2) has become a significant public health issue worldwide. Some researchers have identified a positive link between temperature and COVID-19 cases. However, no detailed research has highlighted the impact of temperature on COVID-19 spread in India. This study aims to fill this research gap by investigating the impact of temperature on COVID-19 spread in the five most affected Indian states. Quantile-on-Quantile regression (QQR) approach is employed to examine in what manner the quantiles of temperature influence the quantiles of COVID-19 cases. Empirical results confirm an asymmetric and heterogenous impact of temperature on COVID-19 spread across lower and higher quantiles of both variables. The results indicate a significant positive impact of temperature on COVID-19 spread in the three Indian states (Maharashtra, Andhra Pradesh, and Karnataka), predominantly in both low and high quantiles. Whereas, the other two states (Tamil Nadu and Uttar Pradesh) exhibit a mixed trend, as the lower quantiles in both states have a negative effect. However, this negative effect becomes weak at middle and higher quantiles. These research findings offer valuable policy recommendations.

Frequency of subclinical hypothyroidism in chronic kidney disease patients

Objective: Objective of this study was to determine the frequency of sub clinical hypothyroidism among chronic kidney disease patients in our population. Study Design: Descriptive Cross sectional study. Settings: Department of Nephrology, Khyber Teaching Hospital Peshawar. Period: February 2018 to September 2018. Material & Methods: A total of 145 chronic kidney disease patients were included in this study. Thyroid function tests (TFT, s) were performed in all patients along with history and clinical examination. Sub clinical hypothyroidism was defined as high TSH (normal value 0.27-4.0 µIU/ml) and normal Free T47. (0.93 – 1.70 ng/dl). Results: Our study shows that Mean age was 55 years with standard deviation ± 2.83. Eighty seven (60%) patients were male and 58(40%) patients were female. Moreover, 25% patients had subclinical hypothyroidism. Conclusion: Our study concludes that the incidence of subclinical hypothyroidism in chronic kidney disease was found to be 25% in our population.

Is IS PSEUDOEXFOLIATION A SIGNIFICANT RISK FACTOR FOR GLAUCOMA? A CROSSSECTIONAL ANALYSIS OF A PAKISTANI POPULATION

Objective: To determine the association between pseudoexfoliation and glaucoma. Study Design: Cross-sectional analytical study. Place and Duration of Study: Eye Outpatient department of Combined Military Hospital, Multan from Jan to Dec 2019. Methodology: A total of 170 patients reporting to the eye outpatient department were examined for the presence of Pseudoexfoliation and glaucoma based on raised intraocular pressure >21mm Hg, increased cup disc ratio and visual field defects. Therefore, a total of 340 eyes were examined. Results: Out of a total of 252 eyes with pseudoexfoliation, 40 (15.9%) had glaucoma. This frequency of glaucoma was significantly higher in eyes with pseudoexfoliation 87 (98.9%), in comparison to eyes without pseudoexfoliation 1 (1.1%); p<0.01). Conclusion: Pseudoexfoliation was found to be strongly associated with glaucoma.

Upper tract imaging modality to investigate haematuria: cancer detection rates and changing guidelines

Background

To assess the imaging modalities used to investigate both visible haematuria and non-visible haematuria along with their detection rate of malignancy at two hospitals and the corresponding radiological workload produced.

Methods

A retrospective study was conducted across two hospitals. All CT urograms and ultrasound scans investigating haematuria in the outpatient setting over a 12-month period were evaluated.

Results

The detection rate for upper tract urothelial cancer with visible haematuria was 0.97% and for renal cell carcinoma was 0.64%. Of all the CT urograms performed for non-visible haematuria 4.9% had suspicious findings but none of these represents an underlying malignancy. Of all the ultrasound scans performed for either visible or non-visible haematuria, none were shown to have an underlying malignancy. The detection rate was thus zero for an upper tract urinary cancer or renal cell carcinoma in the non-visible haematuria group. A CT urogram was performed in 27% and 67% of cases in each respective hospital to further investigate non-visible haematuria. CT urography makes up 2.3% and 5.2% of each hospitals overall respective workload in the CT department. CT urography to investigate non-visible haematuria could be replaced by ultrasound in low-risk patients.

Conclusions

Radiological investigations are a limited resource and better rationalisation of upper tract imaging is needed in the setting of haematuria. Risk stratification of patients would be of benefit to help prevent a significant delay in timely diagnostics for higher risk individuals presenting with haematuria.

Comparative analysis of revascularization with percutaneous coronary intervention versus coronary artery bypass surgery for patients with end-stage renal disease: a nationwide inpatient sample database

BACKGROUND

The role of percutaneous coronary intervention (PCI) vs coronary artery bypass grafting (CABG) in patients with coronary artery disease (CAD) and concomitant end-stage renal disease (ESRD) remains unknown.

RESEARCH DESIGN & METHODS

The National Inpatient Sample (NIS) (2002-2017) was queried to identify all cases of CAD and ESRD. The relative merits of PCI vs CABG were determined using a propensity-matched multivariate logistic regression model. Adjusted odds ratios (aOR) for mortality and other in-hospital complications were calculated.

RESULTS

A total of 350,623 [CABG = 112,099 (32%) and PCI = 238,524 (68%)] hospitalizations were included in the analysis. The overall adjusted odds for major bleeding (aOR 1.28, 95% CI 1.25-1.31, P < 0.0001), post-procedure bleeding (aOR 5.19, 95% CI 4.93-5.47, P < 0.0001), sepsis (aOR 1.29, 95% CI 1.26-1.33, P < 0.0001), cardiogenic shock (aOR 1.23, 95% CI 1.20-1.26, P < 0.0001), and in-hospital mortality (aOR 1.65, 95% CI 1.61-1.69, P < 0.0001) were significantly higher for patients undergoing CABG compared with PCI. The need for intra-aortic balloon pump (IABP) placement (aOR 2.52, 95% CI 2.45-2.59, P < 0.001) was higher in the CABG group, while the adjusted odds of vascular complications were similar between the two groups (aOR 0.99, 95% CI 0.94-1.06, P = 0.82). As expected, patients undergoing CABG had a higher mean length of stay and mean cost of hospitalization.

CONCLUSION

CABG in ESRD may be associated with higher in-hospital complications, increased length of stay, and higher resource utilization.

A secure key dependent dynamic substitution method for symmetric cryptosystems

The biggest challenge for symmetric cryptosystems is to replace their static substitution with dynamic substitution, because static substitution S-boxes make the symmetric block ciphers more vulnerable to attacks. Previous well-known dynamic key-dependent S-boxes are lacking in dynamicity and do not provide optimal security for symmetric block ciphers. Therefore, this research aims to contribute an effective and secure method for designing key-dependent dynamic S-box with dynamic permutations to make the symmetric block ciphers optimally secure. The proposed S-box method has been experimentally evaluated through several measures such as bit independence criteria, non-linearity, hamming distance, balanced output, strict avalanche criteria including differential and linear approximation probabilities. Moreover, the randomness properties of proposed method have also been evaluated through several standard statistical tests as recommended by the National Institute of Standards and Technology (NIST). Thus, the results show that the proposed method, not only retains effective randomness properties but it also contains, good avalanche effect (up to 62.32%) which is significantly improved than others. Therefore, the proposed substitution method is highly sensitive to the secret key because, only a single bit change in key generates an entirely new S-box with all 256 values at different positions. Thus, the overall evaluation shows that the proposed substitution method is optimally secure and outperforming as compared to the existing S-box techniques. In future, the proposed method can be extended for different key sizes (192-256 bits) or even more.

Another outlook to sector-level energy consumption in Pakistan from dominant energy sources and correlation with economic growth

The present study seeks to investigate the sector-level energy consumption of oil and natural gas and to explore the linkage between economic growth, households, agriculture, industry, power, fertilizers, and commercial sector in Pakistan for the period of 1980-2016. The energy sector of Pakistan is facing severe crisis from the last few years due to inadequate production and supply. Long-lasting deficits of natural gas and oil, the two supreme types of fuel in Pakistan, had detrimental consequences for the growth as well as for the economic development. An autoregressive distributed lag (ARDL) method and Granger causality test under vector error correction model (VECM) were employed to check the association among the variables. Furthermore, the innovative accounting method was used to investigate the responsiveness of each variable to another within the study framework. Empirical results show long-run association among the variables, as oil consumption in the agriculture and power sector show a positive effect on Pakistan's economic growth. Similarly, energy consumption from natural gas in the households and fertilizers as well as in the industry sector has had a constructive association with economic growth. In contrast, energy consumption from oil in the households and industry sectors has adverse association with economic growth, while natural gas consumption in the commercial sector has negative linkage with economic growth. Possible steps should be taken by the Government of Pakistan to enhance the production of oil and natural gas from other alternatives to meet the requirements of these sectors.

Terlipressin effect on hepatorenal syndrome: Updated meta-analysis of randomized controlled trials

Background and Aim

Hepatorenal syndrome (HRS) is a fatal complication of liver cirrhosis with a limited pharmacological option. Terlipressin is a vasoconstrictor that is approved in many countries but not yet in the United States. This is a meta‐analysis of randomized controlled trials (RCTs) to review terlipressin effect on HRS and the safety profile.

Methods

We searched electronic databases for RCTs comparing terlipressin versus placebo in addition to albumin in patients with type 1 or 2 HRS. Primary outcome was HRS reversal. Secondary outcomes were change in serum creatinine (Cr), requirement for renal replacement therapy (RRT) at 30 days of randomization, and 90‐day survival. Risk ratios (RRs) and mean differences (MD) were calculated with 95% confidence intervals (CIs) using a random‐effects model.

Results

We identified eight RCTs with a total of 974 patients, and median follow up of 100 days. Mean age was 55 ± 10 years, 61% were males. Alcoholic liver disease represented 56%. Compared with placebo, terlipressin was associated with a significantly higher likelihood of HRS reversal (RR 2.08; 95% CI [1.51, 2.86], P < 0.001), significantly lower serum Cr (MD −0.64; 95% CI (−1.02, −0.27), P < 0.001], and a trend toward less RRT requirements (RR 0.61; 95% CI [0.36, 1.02], P = 0.06). There was no difference in survival at 90 days between groups (RR 1.09; 95% CI (0.84, 1.43), P = 0.52). Major adverse effects (AEs) were gastrointestinal cramps, discomfort, and respiratory distress.

Conclusion

In patients with liver cirrhosis complicated by HRS, terlipressin was associated with significant HRS reversal and decrease in serum Cr. No survival benefit was detected at 90 days.

Water stable graphene oxide metal-organic frameworks composite (ZIF-67@GO) for efficient removal of malachite green from water

Malachite green (MG) is extensively applied in aquaculture worldwide as a therapeutic agent. MG and its primary metabolite leucomalachite green (LMG) are commonly detected in aquaculture products. MG can cause serious health concerns (in vivo carcinogenic/genotoxic). The extensive water solubility of MG leads to water pollution and hence it is mandatory to remove MG from water. The current study explores adsorptive removal of MG from water using highly water stable Zeolitic Imidazolate framework/graphene oxide composites (ZIF-67@GO). Adsorption performance of newly synthesized composites is justified for MG removal with excellent results of pseudo second order (R² = 0.99955) which is well-fitted in this case. ZIF-67@GO data of adsorption isotherm for MG is observed using Freundlich Model (R² = 0.99999) and with adsorption capacity value observed (134.79 mg/g) with removal efficiency of 99.18%, indicates π-staking and electrostatic association between ZIF-67@GO and MG molecules. Synthesized material has retained reusability while removal efficiency reduced only by 6% after many cycles. Furthermore, factors effecting absorption like contact time, pH, adsorbent dose and quantity and temperature are also determined.

POS1056 COMPARATIVE EFFICACY OF TNF INHIBITORS VERSUS OTHER CYTOKINE INHIBITOR bDMARDs ON PSORIATIC ARTHRITIS IMPACT OF DISEASE (PsAID) SCORE AND DOMAINS

Background:

Psoriatic arthritis (PsA) has many consequences, reflecting musculoskeletal and skin inflammation, with the potential to adversely affect overall quality of life. Patient reported outcome measures (PROM) assess a holistic range of aspects of quality of life, including physical and mental components, and provide broad detailed information of the impact of disease. Biologic DMARDs (bDMARDs) targeting TNF have been used to treat PsA for over 10 years whereas inhibitors of IL-17, IL-12/23 and Janus kinases (JAK) have only been available more recently. They all target differing cytokines, including JAK inhibitors which inhibit IL-12 and IL-23 signaling but not TNF signaling. Their relative impact on PROMs is unknown.

Objectives:

To assess, in routine care, the relative impact in PsA of TNF inhibitors (TNFi) versus non-TNFi bDMARDs, targeting IL-17, IL-12/23 and JAK, on PROMs.

Methods:

We performed a cross section analysis of PsA patients with established disease treated with bDMARDs and JAKi, under routine care at St George’s University Hospital, London, UK. Patients completed the 12-item psoriatic arthritis impact of disease (PsAID) tool. The total PsAID score was calculated using the on-line EULAR toolkit (see reference). The PsAID total and individual domain scores were compared between TNFi and non-TNFi groups using the Mann Whitney U test. A total PsAID score below 4 out of 10 is considered a ‘patient-acceptable state’.

Results:

A total 95 patients (female n= 53, 56%) completed the PSAID; TNFi n=72 (female 50%, adalimumab n=41, Etanercept n= 24, Golimumab n=4, Infliximab n =2, Certolizumab n=1) and non-TNFi n= 23 (female 74%, Secukinumab n=9, Ixekizumab n=1, Ustekinumab n=9, Tofacitinib n=4). The mean age was 53.6 (TNFi 53.5, non-TNFi 53.7) years, and duration of time on bDMARD treatment was TNFi 49.5 (range 1- 141) months, non-TNFi 25.3 (range 4 -59) months. The total and individual domain PsAID scores are shown in the Table 1. A ‘patient acceptable state’ total score <4 was recorded in TNFi 36/72 (50%) and non-TNFi 11/23 (48%). There was no significant difference between TNFi and non-TNFi groups in the mean total PsAID score, or proportion achieving a patient acceptable state. Patients on TNFi had lower (better outcome) mean scores for all 12 domains except skin, and the differences, versus non-TNFi treated patients, were significant for pain, functional capacity, discomfort and depression.

PSAID domainTNFiNon-TNFiP valueTotal score3.314.64N.S.Pain3.675.430.02Fatigue4.045.65N.S.Skin problems3.112.78N.S.Work/leisure activities3.564.78N.S.Functional capacity3.295.040.02Discomfort3.885.650.02Sleep disturbance3.424.78N.S.Coping3.014.09N.S.Anxiety, fear, uncertainty2.644.17N.S.Embarrassment/shame2.283.39N.S.Social participation2.63.48N.S.Depression2.113.910.03

Conclusion:

In PsA, TNFi appear to have a greater impact over non-TNFi bDMARDs on some aspects of quality of life, including pain and functional capacity. TNFi and non-TNFi were no different with respect to patients’ perspective on skin disease, embarrassment or shame, despite less good cutaneous responses in clinical trials from TNFi agents. Overall, the PsAID tool reveals an unmet burden on quality of life in PsA patients treated with all classes of bDMARDs and JAKi, as 50% fail to achieve a ‘patient acceptable state’. This should prompt scrutiny of the high scoring domains and utilization of additional treatment modalities to achieve better holistic outcomes for PsA patients in routine care.

References:

[1]PsAID tool: http://pitie-salpetriere.aphp.fr/psaid/raid_psaid_quest_home.php

Disclosure of Interests:

Atif Rauf: None declared, Catherine Hughes: None declared, Diane Hill: None declared, Patrick Kiely Speakers bureau: Abbvie.