Eating Disorders and Disordered Eating Behaviors Among Undergraduate Students in Pakistan as Measured by Eating Disorder Examination Questionnaire (EDE-Q).

Objectives Eating disorders (ED) are an emerging public health issue globally, especially in young adults studying at the undergraduate level. This study aims to assess the frequency of eating disorders, their types, and disordered eating behaviors among such students. Moreover, it aims to identify factors like weight concern, shape concern, eating concern, and restraint, along with assessing the shifting trend of BMI impact on eating disorders using a standardized Eating Disorder Examination Questionnaire (EDE-Q). Methods In this cross-sectional study, 400 undergraduate students (aged 18-25) from four public universities participated from July 2022 to November 2023. Data was collected using the Eating Disorder Examination Questionnaire (EDE-Q). The frequency of eating disorders was computed using SPSS version 27. Results Among the participants, 21.75% (n=84) were identified as having a score surpassing the clinical cut-off. This group comprised 5.5% males (n=22) and 16% females (n=64). The highest prevalence among the four subscales was observed in the Shape Concern subscale (10.5%). Objective binge episodes (19.3%) emerged as the most notable disordered eating attitude. Atypical anorexia nervosa accounted for 13.8% of different eating disorders, while disordered eating was noted in 19.5% (n=78) of individuals. Discussion This study offers critical insights into eating disorders among Pakistan undergraduate students, utilizing the EDE-Q 6.0. Disordered eating behaviors, particularly shape concern and objective binge eating, exhibit significant correlations with these disorders. Weight dissatisfaction emerges as a prominent predictor, suggesting societal influence. The study also reveals a moderate correlation between BMI and eating disorders, challenging conventional assumptions. Furthermore, a changing trend in the prevalence of eating disorders is observed among the male population.

Knowledge, Attitude and Practice Related to Chemotherapy Among Cancer Patients.

Cancer is a leading cause of death, with a rapidly increasing global burden. Chemotherapy is the most effective cancer treatment, and with its benefits, there exist potential problems. The present study assesses cancer patients' knowledge, attitude, and practice toward chemotherapy use. A descriptive cross-sectional study was conducted in the oncology wards of various tertiary care hospitals and cancer care centers in Lahore, Pakistan. Patients were included in the study based on convenient sampling. A structured questionnaire with 25 (close-ended) questions and a demographic profile was used to collect data. Descriptive statistics was used to analyze frequencies and percentages. Independent sample t-test and ANOVA were used to calculate the mean and standard deviation. Most patients were females (54%) and married (52.6%), with an unemployment rate of 39%. Patients with higher education depicted significantly higher scores in knowledge (9.61 ± 2.65), attitude (19.37 ± 2.70), and practice (3.89 ± 1.03) domains. Surprisingly, throughout the whole KAP domain, the patient's attitude (18.42 ± 3.31) toward chemotherapy use, showed higher values, as compared to their knowledge (7.78 ± 3.26) and practice (3.66 ± 1.08) scores. The majority of the study participants had a positive attitude toward chemotherapy use, with limited knowledge, and practice.

The influence of environmental diplomacy, economic determinants and renewable energy consumption on environmental degradation: Empirical evidence of G20 countries.

This study examines how various environmental and economic variables contribute to environmental degradation. Industrialization, trade openness, and foreign direct investment are among the variables, as are environmental diplomacy, environmental diplomacy secure, and renewable energy consumption. Therefore, the data covers the years 1991-2020, and our sample includes all 19 countries and two groups (the European Union and the African Union). The research used the Pesaran CD test to determine cross-section dependency, CIPS and CADF test to determine stationarity, the Wald test for hetrodcedasasticity and the Wooldridge test for autocorrelation; therefore, VIF for multicollinearity, Durbin and Hausman to analyze the endogeneity. It also employed Westerlund's cointegration test to ensure cross-sectional dependence, Wald test for group-wise heteroscedasticity, Wooldridge test for autocorrelation, VIF for multicollinearity, and Durbin and Hausman for endogeneity. The two-step system generalized method of moments (GMM) is used to estimate the results and confirm the relationship between independent variables (Industrialization, trade openness, FDI, environmental diplomacy, secure environmental diplomacy, and renewable energy) and dependent variables (Environmental Degradation) in G20 countries. Therefore, Industrialization, trade openness, foreign direct investment, ecological diplomacy, and renewable energy consumption significantly impact ecological degradation. Environmental diplomacy is crucial to combat degradation and stimulate global collaboration. G20 nations enact strict environmental restrictions to tackle climate change and encourage economic growth.

Resilience in maize production for food security: Evaluating the role of climate-related abiotic stress in Pakistan.

The primary purpose of this research is to examine the impact of climate change on maize production in Pakistan. This research studied the impact of climate change on maize production in Pakistan from 1990 to 2020 using the Auto Regressive Distributed Lag (ARDL) technique and draws implications for the future of Pakistan's sustainable agricultural industry. According to ARDL's short-run and long-run analyses, variables such as average temperature (AVEGTP), carbon dioxide (CO2), precipitation (PRPT), and tube well irrigation (TWL) all have a significant short-run and long-run impact on maize yield at the 1 %, 5 %, and 10 % significance levels. The estimated findings were also affirmed through FMOLS and DOLS. The study's key findings indicated that variables such as average temperature, carbon dioxide, precipitation, and tube well irrigation had significant short-run and long-run impacts on maize yield. Climate change's impacts on maize yield underline the crucial need for action to address this global issue and ensure agriculture's future. A recent study has emphasized the significant impact of climate change on Pakistan's maize production, stressing the importance of addressing this global issue for food security. The study recommends selecting crop varieties and managing fertilizer applications based on projected climate change to mitigate the impending crisis. Policymakers can use the study's findings as valuable insights to formulate effective policies that ensure the resilience and sustainability of Pakistan's agricultural industry.

Estimating Nitrogen Use Efficiency, Profitability, and Greenhouse Gas Emission Using Different Methods of Fertilization.

Fertilization is a way to better use nitrogen fertilizers and increase productivity, but in another way, fertilization is also a source of anthropogenic greenhouse gas emissions. The study was carried out to measure the profitability ratio, technical efficiency, and CO2 from the top dressing (TD) and deep placement (DP) fertilization. The study was based on primary data, which were collected from different respondents and areas through a well-designed questionnaire. The study finds that DP fertilization is more profitable, least costly, and more efficient than TD fertilization. The finding observed that the yield of the TD growers is 727.82 kg/ha more than that of TD respondents. The efficiency score shows that to reach the 90% efficiency level, the farmers of TD need to use DP fertilization. The farmers of TD and DP can still increase their efficiency up to 12% and 9% by using the same inputs. The findings also clarify that manufacturing of synthetic nitrogen (N), direct use of N, Yield, and Area-Scaled greenhouse gas (GHG) emissions from the use of synthetic N through TD fertilization are greater than that of the DP group. The farming community needs to be aware of greenhouse gas emissions and how they can be reduced. It is also suggested that farmers need to shift toward DP fertilization to increase yield, profit, efficiency, food security, and reduce GHG emissions.

A Survey of Broiler Farmers' Perceptions of Animal Welfare and their Technical Efficiency: A Case Study in Northeast China.

This study was conducted to assess the current status of famers' perceptions of animal welfare and technical efficiency in broiler farms using a stochastic frontier analysis (SFA). In this study, 355 farms registered in Heilongjiang Province, China were surveyed, with 240 of them responding. The results showed that 75% of farmers recognize the importance of animal welfare, and 56.3% of them expressed their willingness to implement animal welfare on their farms without conditions or having a negative attitude. The technical efficiency of the farmers' ranged from 55% to 99%. All the variables assessed in this study had a statistical influence on production. Education, experience, and gender of farmers were significant variables and increased efficiency, while age and distance of a farm to the main road increased inefficiency. Based on our survey, we suggest that the implementation of animal welfare measures will require government subsidy or incentive, which could encourage 35% of farmers to implement animal welfare measures. To increase production efficiently, farmer needs to control the mortality rate, but the contribution of vaccine during production is below 1% (0.09%).

On the asymmetric effects of insurance sector development on environmental quality: challenges and policy options for BRICS economies.

This study contributes to the empirical literature by analyzing the dynamic impacts of insurance sector development on CO2 emissions of emerging economies for the period of 1991-2018. By using the nonlinear autoregressive distributed lag (NARDL) approach, our findings show that increased life insurance sector development significantly reduces CO2 emissions of Russia, China and South Africa and decreased life insurance sector development significantly enhances CO2 emissions of Russia only. While China and South Africa have also reduced CO2 emissions due to the negative shock of life insurance sector development in the long run. Findings also show that increased non-life insurance sector development boosts CO2 emissions in Russia and China, while negatively significant in case of South Africa. Moreover, decreased non-life insurance sector development reduces CO2 emissions in Russia, India and China and positively significant in case of South Africa in long run. The short-run outcomes are also country-specific in our analysis. Finally, we provide some helpful suggestions for investors, and consumers and policy-makers.

An asymmetric analysis of the impacts of energy use on carbon dioxide emissions in the G7 countries.

The foremost theme of the paper is to explore the asymmetric/symmetric impact of energy consumption on the carbon dioxide emission of G7 countries (Germany, Canada, USA, Italy, France, Italy, UK, and Japan). The nonlinear autoregressive distributed lag is used to measure asymmetric/symmetric cointegration by using annual data of G7 countries from 1965 to 2019. The augmented Dickey-Fuller and structural break unit root test is employed to measure the stationarity in variables while the Brock, Dechert, and Scheinkman test is used for measuring nonlinearity and the Wald test is used to figure out short- and long-run asymmetries/symmetries, respectively. The estimated findings of the nonlinear autoregressive distribution lag model show a significant effect of energy use on the ecological footprint. The asymmetric causality test provides evidence of unidirectional, bidirectional, and asymmetrical/symmetrical causality among the variables of G7 nations. The finding of the study suggested policy for the government of Canada and France to use coal instead of oil and gas while the USA, Germany, Italy, UK, and Japan are required to consume gas as compared to oil and coal. Similarly, the study also suggests using modern technology, renewable energy, and preventive measurement for ensuring environmental betterment.

Ammonia inhalation-induced inflammation and structural impairment in the bursa of fabricius and thymus of broilers through NF-κB signaling pathway.

Ammonia (NH3) is a toxic, environmental pollutant, and irritant gas. Previous studies reported the toxic effects of NH3 which led to inflammation in various organs of chicken. However, the exact mechanism of NH3-induced inflammation in chicken lymphoid organs bursa of fabricius (BF) and thymus is still elusive. Thus, this study was designed to investigate NH3-induced inflammation in chicken BF and thymus. Experimental chickens were divided into low (5.0 mg/m3), middle (10.0-15.0 mg/m3), and high (20.0-45.0 mg/m3) NH3-treated groups. To investigate NH3-induced inflammation in chicken's BF and thymus, histological observation, NO content and iNOS activity, inflammatory cytokine contents, and mRNA levels were performed by light microscopy, microplate spectrophotometer, ELISA assay, and qRT-PCR. The finding of the present study showed that NH3 exposure reduced BF and thymus index, increased nitric oxide (NO) content and inducible nitric oxide synthase (iNOS) activity, inflammatory cytokine contents and mRNA levels of nuclear factor-kappa B (NF-κB), cyclooxygenase-2 (Cox-2), tumor necrosis factor alpha (TNF-α), interleukin 6 (IL-6), IL-10, IL-1ß, IL-18, toll-like receptor 2A (TLR-2A), and iNOS. Histopathological examination revealed signs of inflammation including increased nuclear debris and vacuoles in the cortex and medulla of thymus and bursal follicles. Conclusively, our findings displayed that NH3 exposure affects the normal function of BF and thymus and led inflammation. The data provided a new ground for NH3-induced toxicity and risk assessment in chicken production.

Early Active Mobilization Vs Immobilization Following Modified Kessler Repair Of Extrinsic Extensor Tendons In Zone V TO VII.

BACKGROUND: The long-disputed issue of rehabilitation of extensor tendon repairs in zones V-VII has been treated with either complete immobilization or mobilization within the constraints of splint. In recent times, most authors have preferred some mobilization. Many studies have shown good results with early mobilization techniques; however, these studies have limitations. Most of these are retrospective observations. Some prospective studies are without proper controls. This study was conductive to compare the functional outcome of early active mobilization versus immobilization following repair of extensor tendons in zone V-VII. METHODS: Functional outcome was determined by total active motion, pain and complications during rehabilitation. Total active motion (TAM) was graded by scores of the American Society for Surgery of Hand as TAM=total active flexion (MCP+PIP+DIP)-total extension deficit (MCP+PIP+DIP). A randomized control trial was conducted including 50 subjects of with extensor tendon injury exclusively in zone V-VII. Patients were divided randomly in two groups. All extensor tendon repairs (zone V to VII) were performed with modified Kessler's method. The pain and TAM was assessed during all visits in both groups except TAM in group B that was assessed after four weeks. RESULTS: We found that outcome of 12% cases in Group A as excellent and no patient fell in category of fair results. While, in comparison, there was no case of excellent result in Group B. 4% cases showed fair results that were treated with immobilization. The pain score at the end of treatment, i.e., at 12 weeks were same in both the groups but, generally the score remained higher in group of EAM. There was significant difference in adhesion formation that was more in patients of immobilization group. The overall suture dehiscence was insignificant and was only 8% in each group. CONCLUSIONS: EAM has better outcome in terms of pain and range of motion.

Risk Factors of Incidental Parathyroidecomy in Thyroid Surgery.

BACKGROUND: Incidental parathyroidectomy with subsequent hypoparathyroidism and postoperative hypocalcemia is thought to be one of the common complications of thyroidectomy. Current literature reports wide discrepancy in incidence and risk factors. OBJECTIVES: The aim of our study was to evaluate the incidence and risk factors of incidental parathyroidectomy in thyroid surgery. METHODS: A retrospective study included 270 patients who had thyroid surgery that was performed over two years from January 2017 to December 2018 in two tertiary care hospitals. Preoperative and postoperative records were assessed. Factors such as gender, diagnosis, type of surgery, and usage of surgical loupes during the procedure were evaluated and were compared to find the association with incidental parathyroidectomy in thyroid surgery. RESULTS: Incidental parathyroidectomy was noticed in 62 (23%) surgical specimens during histopathologic examination. There was no significant association between incidental parathyroidectomy and sex of patient, use of surgical loupes, pathology of thyroid disease, or neck dissection. CONCLUSION: Although the risk of incidental parathyroidectomy is inevitable, careful dissection and meticulous intraoperative identification of parathyroid gland during thyroidectomy can reduce the incidence of incidental parathyroidectomy, thereby minimizing the risk of postoperative hypoparathyroidism and hypocalcemia.

Elemental balance of SRF production process: solid recovered fuel produced from municipal solid waste.

In the production of solid recovered fuel (SRF), certain waste components have excessive influence on the quality of product. The proportion of rubber, plastic (hard) and certain textiles was found to be critical as to the elemental quality of SRF. The mass flow of rubber, plastic (hard) and textiles (to certain extent, especially synthetic textile) components from input waste stream into the output streams of SRF production was found to play the decisive role in defining the elemental quality of SRF. This paper presents the mass flow of polluting and potentially toxic elements (PTEs) in SRF production. The SRF was produced from municipal solid waste (MSW) through mechanical treatment (MT). The results showed that of the total input chlorine content to process, 55% was found in the SRF and 30% in reject material. Of the total input arsenic content, 30% was found in the SRF and 45% in fine fraction. In case of cadmium, lead and mercury, of their total input content to the process, 62%, 38% and 30%, respectively, was found in the SRF. Among the components of MSW, rubber material was identified as potential source of chlorine, containing 8.0 wt.% of chlorine. Plastic (hard) and textile components contained 1.6 and 1.1. wt.% of chlorine, respectively. Plastic (hard) contained higher lead and cadmium content compared with other waste components, i.e. 500 mg kg(-1) and 9.0 mg kg(-1), respectively.

Mass, energy and material balances of SRF production process. Part 3: solid recovered fuel produced from municipal solid waste.

This is the third and final part of the three-part article written to describe the mass, energy and material balances of the solid recovered fuel production process produced from various types of waste streams through mechanical treatment. This article focused the production of solid recovered fuel from municipal solid waste. The stream of municipal solid waste used here as an input waste material to produce solid recovered fuel is energy waste collected from households of municipality. This article presents the mass, energy and material balances of the solid recovered fuel production process. These balances are based on the proximate as well as the ultimate analysis and the composition determination of various streams of material produced in a solid recovered fuel production plant. All the process streams are sampled and treated according to CEN standard methods for solid recovered fuel. The results of the mass balance of the solid recovered fuel production process showed that 72% of the input waste material was recovered in the form of solid recovered fuel; 2.6% as ferrous metal, 0.4% as non-ferrous metal, 11% was sorted as rejects material, 12% as fine faction and 2% as heavy fraction. The energy balance of the solid recovered fuel production process showed that 86% of the total input energy content of input waste material was recovered in the form of solid recovered fuel. The remaining percentage (14%) of the input energy was split into the streams of reject material, fine fraction and heavy fraction. The material balances of this process showed that mass fraction of paper and cardboard, plastic (soft) and wood recovered in the solid recovered fuel stream was 88%, 85% and 90%, respectively, of their input mass. A high mass fraction of rubber material, plastic (PVC-plastic) and inert (stone/rock and glass particles) was found in the reject material stream.

Mass, energy and material balances of SRF production process. Part 2: SRF produced from construction and demolition waste.

In this work, the fraction of construction and demolition waste (C&D waste) complicated and economically not feasible to sort out for recycling purposes is used to produce solid recovered fuel (SRF) through mechanical treatment (MT). The paper presents the mass, energy and material balances of this SRF production process. All the process streams (input and output) produced in MT waste sorting plant to produce SRF from C&D waste are sampled and treated according to CEN standard methods for SRF. Proximate and ultimate analysis of these streams is performed and their composition is determined. Based on this analysis and composition of process streams their mass, energy and material balances are established for SRF production process. By mass balance means the overall mass flow of input waste material stream in the various output streams and material balances mean the mass flow of components of input waste material stream (such as paper and cardboard, wood, plastic (soft), plastic (hard), textile and rubber) in the various output streams of SRF production process. The results from mass balance of SRF production process showed that of the total input C&D waste material to MT waste sorting plant, 44% was recovered in the form of SRF, 5% as ferrous metal, 1% as non-ferrous metal, and 28% was sorted out as fine fraction, 18% as reject material and 4% as heavy fraction. The energy balance of this SRF production process showed that of the total input energy content of C&D waste material to MT waste sorting plant, 74% was recovered in the form of SRF, 16% belonged to the reject material and rest 10% belonged to the streams of fine fraction and heavy fraction. From the material balances of this process, mass fractions of plastic (soft), paper and cardboard, wood and plastic (hard) recovered in the SRF stream were 84%, 82%, 72% and 68% respectively of their input masses to MT plant. A high mass fraction of plastic (PVC) and rubber material was found in the reject material stream. Streams of heavy fraction and fine fraction mainly contained non-combustible material (such as stone/rock, sand particles and gypsum material).

Efficacy and tolerability of carbamazepine for the treatment of painful diabetic neuropathy in adults: a 12-week, open-label, multicenter study.

OBJECTIVE: Anticonvulsants are increasingly being used in the symptomatic management of several neuropathic pain disorders. The present observational study was designed to evaluate the efficacy, tolerability, and quality of life (QoL) of carbamazepine use for 12 weeks in patients with painful diabetic neuropathy, in Pakistan. METHODS: This was a 12-week, multicenter, open-label, uncontrolled trial in adult type 2 diabetic patients (aged 18-65 years) suffering from clinically confirmed neuropathic pain (Douleur Neuropathique en 4 [DN4] score ≥4). Change in neuropathic pain at week 12 compared with baseline was assessed using the Brief Pain Inventory Scale-Short Form (pain severity score and pain interference score). QoL was determined by the American Chronic Pain Association QoL scale. Safety was assessed based on patient reported adverse events (AEs) and serious AEs. RESULTS: Of the total 500 screened patients, 452 enrolled and completed the study. The mean (± standard deviation [SD]) pain interference score decreased from 4.5±2.0 at baseline to 3.1±1.9 at week 12 (P<0.001). The mean (± SD) pain severity score decreased from 5.8±2.0 at baseline to 3.6±2.2 at week 12 (P<0.001). There was a decrease of ≥30% in the pain severity score between visits. The mean (± SD) QoL scale score improved from 5.9±1.6 at baseline to 8.0±1.7 at week 12. A total of ten (2.2%) patients reported AEs during the study period. No patient discontinued the study due to AEs. CONCLUSION: In this real-life experience study, carbamazepine, when prescribed for 12 weeks to adult diabetic patients suffering from neuropathic pain, showed pain-relief effect, with reduced mean pain severity and mean pain interference scores and with improved QoL and good tolerability profile.

Mass, energy and material balances of SRF production process. Part 1: SRF produced from commercial and industrial waste.

This paper presents the mass, energy and material balances of a solid recovered fuel (SRF) production process. The SRF is produced from commercial and industrial waste (C&IW) through mechanical treatment (MT). In this work various streams of material produced in SRF production process are analyzed for their proximate and ultimate analysis. Based on this analysis and composition of process streams their mass, energy and material balances are established for SRF production process. Here mass balance describes the overall mass flow of input waste material in the various output streams, whereas material balance describes the mass flow of components of input waste stream (such as paper and cardboard, wood, plastic (soft), plastic (hard), textile and rubber) in the various output streams of SRF production process. A commercial scale experimental campaign was conducted on an MT waste sorting plant to produce SRF from C&IW. All the process streams (input and output) produced in this MT plant were sampled and treated according to the CEN standard methods for SRF: EN 15442 and EN 15443. The results from the mass balance of SRF production process showed that of the total input C&IW material to MT waste sorting plant, 62% was recovered in the form of SRF, 4% as ferrous metal, 1% as non-ferrous metal and 21% was sorted out as reject material, 11.6% as fine fraction, and 0.4% as heavy fraction. The energy flow balance in various process streams of this SRF production process showed that of the total input energy content of C&IW to MT plant, 75% energy was recovered in the form of SRF, 20% belonged to the reject material stream and rest 5% belonged with the streams of fine fraction and heavy fraction. In the material balances, mass fractions of plastic (soft), plastic (hard), paper and cardboard and wood recovered in the SRF stream were 88%, 70%, 72% and 60% respectively of their input masses to MT plant. A high mass fraction of plastic (PVC), rubber material and non-combustibles (such as stone/rock and glass particles), was found in the reject material stream.

Creutzfeldt-Jakob disease.

Creutzfeldt-Jakob disease is a prion related disease, characterized by rapidly progressive dementia, associated with myoclonus and ataxia. A 55-year-old male, who initially developed depressive symptoms and obsessive-compulsive disorder one year before presentation, and in due course, developed ataxia, forgetfulness and disorientation in time and space followed by myoclonic jerks with increasing difficulty in walking, finally becoming bed bound and developing startle response to sound and touch, presented in mute and bed bound state. On the basis of typical clinical syndrome, suggestive electroencephalography and magnetic resonance imaging, and absence of any other cause, diagnosis of Creutzfeldt-Jakob disease was made.