Shakeel Ahmed

Open Access Article by Muhammad Waqqas Hasan Muhammad Waqqas Hasan Scilit Preprints.org Google Scholar

Peshawar: A high court in Pakistan on Thursday ordered the election commission to decide on the organisational elections and allocation of the election symbol case of former premier Imran

“The sustenance of private practice doctors, like the survival of small bakeries amidst the sprawling dominion of retail giants, nurtures a tapestry of diverse health care providers, ensuring that patients have access to a symphony of medical options in close proximity to their communities.” – Dr. Clarissa Meadowsong, patient advocate and champion of health care diversity.

Background: Up to 30% of hospitalised patients with COVID-19 require advanced respiratory support, including high-flow nasal cannulas (HFNC), non-invasive mechanical ventilation (NIV), or invasive mechanical ventilation (IMV). We aimed to describe the clinical characteristics, outcomes and risk factors for failing non-invasive respiratory support in patients treated with severe COVID-19 during the first two years of the pandemic in high-income countries (HICs) and low middle-income countries (LMICs).Methods: This is a multinational, multicentre, prospective cohort study embedded in the ISARIC-WHO COVID-19 Clinical Characterisation Protocol. Patients with laboratory-confirmed SARS-CoV-2 infection who required hospital admission were recruited prospectively. Patients treated with HFNC, NIV, or IMV within the first 24 h of hospital admission were included in this study. Descriptive statistics, random forest, and logistic regression analyses were used to describe clinical characteristics and compare clinical outcomes among patients treated with the different types of advanced respiratory support.Results: A total of 66,565 patients were included in this study. Overall, 82.6% of patients were treated in HIC, and 40.6% were admitted to the hospital during the first pandemic wave. During the first 24 h after hospital admission, patients in HICs were more frequently treated with HFNC (48.0%), followed by NIV (38.6%) and IMV (13.4%). In contrast, patients admitted in lower- and middle-income countries (LMICs) were less frequently treated with HFNC (16.1%) and the majority received IMV (59.1%). The failure rate of non-invasive respiratory support (i.e. HFNC or NIV) was 15.5%, of which 71.2% were from HIC and 28.8% from LMIC. The variables most strongly associated with non-invasive ventilation failure, defined as progression to IMV, were high leukocyte counts at hospital admission (OR [95%CI]; 5.86 [4.83-7.10]), treatment in an LMIC (OR [95%CI]; 2.04 [1.97-2.11]), and tachypnoea at hospital admission (OR [95%CI]; 1.16 [1.14-1.18]). Patients who failed HFNC/NIV had a higher 28-day fatality ratio (OR [95%CI]; 1.27 [1.25-1.30]).Conclusions: In the present international cohort, the most frequently used advanced respiratory support was the HFNC. However, IMV was used more often in LMIC. Higher leucocyte count, tachypnoea, and treatment in LMIC were risk factors for HFNC/NIV failure. HFNC/NIV failure was related to worse clinical outcomes, such as 28-day mortality. Trial registration This is a prospective observational study; therefore, no health care interventions were applied to participants, and trial registration is not applicable.

This debate hinges on educational qualifications, clinical experience and the evolving nature of healthcare roles.

In the face of pandemic-induced emergencies and unpredictable natural disasters, industries are compelled to implement rescue plans to mitigate unexpected risks. In this context, Overall Equipment Effectiveness (OEE) is considered as a key metric, followed by sustainability efforts to manage unforeseen risks, encompassing social, environmental, and economic aspects. OEE is considered as a lean tool to determine the efficiency of equipment or processes on par with the world class OEE standard, i.e., 85%. Performance, Availability and Quality as three main drivers of OEE. This research study explores the implementation of OEE in conjunction with sustainability principles in an auto sector manufacturing firm, aiming to enhance operational efficiency and sustainability practices. The research involves a 12-week initial session from April to June 2022, followed by an analysis of July to September 2022, resulting in an impressive OEE value of 48%. Notable improvements in Availability (89.75%), Performance (72.68%), and Quality (73.82%) contribute significantly. The analysis reveals enhancements in scrap rework (17%), training (16%), maintenance (13%), material availability (12%), and production capability (11%). Achievements include improvements in green profile (25%), health and safety (20%), and energy efficiency (25%), along with reductions in carbon dioxide emissions (21%), waste management (17%), and scrap (15%). This research underscores the commitment of the case study industry to sustainable development and economic growth, showcasing significant enhancements in product quality and efficiency. The integration of sustainability principles into OEE initiatives is pivotal for modern industrial optimization. The study results highlight the profound significance of this synergistic relationship, particularly within the blending section, driving substantial positive outcomes in manufacturing processes and operational excellence. The implementation of sustainability efforts not only mitigates risks and fosters growth for automotive manufacturers but also yields environmental benefits. Based on findings of this study, a roadmap for automotive manufacturers is devised to achieve robust OEE while concurrently reaping economic and environmental rewards by employing sustainability principles.

“The limits of tyrants are prescribed by the endurance of those whom they oppress.” — Frederick Douglass

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Department of Internal Medicine, General Medicine Practice Program, Batterjee Medical College, Jeddah 21442, Saudi Arabia

Nilofar Nilofar Shakeel Ahmed Gokhan Zengin Simonetta Cristina Di Simone Alessandra Acquaviva