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“Economic War: Ukraine and the Global Conflict between Russia and the West” by Maximilian Hess is not only a historical account of a conflict between Russia and the West but a critical analysis of the economic power struggles between the two. The book explicitly highlights the political problem that emerged when Russian President Vladimir Putin hit Ukraine in 2014 and the economic warfare that followed the event. Hess explores Russian strategies behind the scenes and against the sanctions, focused on pursuing global power. The author’s extensive research and deep analytical skills make the book an essential part of the knowledge impartation related to the intricate economic problems found within the conflict between Russia and the West on an international scale.Maximilian Hess is a political risk analyst, consultant, and research fellow at the Foreign Policy Research Institute. Hess possessed notable strengths in the areas of trade, debts, diplomacy, and foreign policy. These strengths allowed him to become an accomplished writer who could effectively discuss the economic problems that affected Russia and the West. He has authored numerous articles on Russia and its neighbouring countries, which eventually led to the publication of his first book in partnership with Hurst and Oxford University Press in 2023.In “Economic War: Ukraine and the Global Conflict between Russia and the West,” the author asserts that the present confrontation between Russia and the West is not the new Cold War but a struggle to influence the spheres of finance, energy, and capital markets. Economic war is defined as “the use of economic means to achieve geopolitical objectives or the use of geopolitical objectives to achieve economic ends.” Hess merges history with an analysis of the economic war, which has a long-term effect on liberalism, democracy, and the structure of the world’s economy. The author gives a clear and profound description of how the West preferred to use international markets to inflict pain on the Kremlin, and the Russian reaction was to seek the involvement of countries like China, Turkey, and Iran in the process.

This study investigates the interplay between breastfeeding patterns, chemical pathology, and antibiotic resistance in lactating mothers. A cross-sectional analysis was conducted on 1,200 lactating mothers aged 18 to 45, examining breastfeeding practices, biochemical markers, milk composition, and antibiotic resistance status. The findings reveal significant metabolic variations, with mean glucose and cholesterol levels at 135.23 mg/dL and 224.58 mg/dL, respectively, suggesting potential cardiovascular risks. Exclusive breastfeeding improved milk quality by having higher average fat content (3.48%) and lactose (6.96%), and the reported antibiotic resistance was lower (18.2%), compared with non-exclusive groups (28.6%). Geographically weighted regression (GWR) revealed spatial variability in exclusivity effects, highlighting regional nutritional disparities. Machine learning models, random forest, support vector machine (SVM), and gradient boosting machine (GBM), were used to predict resistance and nutritional status, with cholesterol and BMI emerging as the top predictors. Although model performance was modest (AUC ≈ 0.65), random forest achieved moderate discriminative power (AUC ~0.65), with cholesterol and BMI ranked highest in feature importance. Receiver operating characteristic (ROC) analysis for GBM and SVM also indicated moderate predictive capacity. Spatial mapping of antibiotic resistance revealed clustered patterns, emphasizing the need for region-specific interventions. Furthermore, systolic blood pressure showed a weak correlation with cholesterol levels, indicating independent metabolic risks. This study underscores the critical need for integrated nutritional and antimicrobial stewardship in lactating mothers, particularly in regions with identified spatial vulnerabilities. Policy implications suggest targeted nutritional support and regional antibiotic surveillance to mitigate health risks in this population.

Background Lung cancer is the most frequent cause of cancer-related deaths and the most common type of cancer globally. It is generally classified into two main histologic subtypes: non-small cell lung cancer (NSCLC) and small cell lung cancer (SCLC). NSCLC is the most prevalent type and is enriched with genetic and molecular diversity. This study evaluated the clinical, molecular, and demographic characteristics of patients with NSCLC, with a focus on variables involving disease stage, survival rates, and mutations in the epidermal growth factor receptor (EGFR) and anaplastic lymphoma kinase (ALK) genes. Methods This retrospective study included 51 adult patients aged 30 years and older. Only patients who received treatment and subsequent follow-up at our institution were included in this study. Results There were 51 patients, aged 30-84 years (mean = 59.6 ± 10.9). Out of 51 patients, 32 (64.7%) were men; 19 (37.2.5%) were either current or former smokers; 34 patients (66.7%) had an Eastern Cooperative Oncology Group (ECOG) performance status of either 0 or 1; 47 (92.2) had an adenocarcinoma; 15 (29.4%) had a bilateral lung disease; 43 (84.3%) had stage IV disease; 10 (19.6%) had a positive EGFR status; eight (15.7) had a positive ALK status; and 38 patients (73.1%) had died by the cut-off date for this study. The median survival time for the EGFR-negative patients was 15 months, as opposed to 16 months for those who were EGFR-positive. Likewise, the median survival time for both the ALK-negative and positive patients was 17 months each. Conclusion The study contributes to our understanding of NSCLC and highlights the trends of our region while acknowledging the limitations associated with molecular studies and smaller sample sizes. These findings are not aligned with global trends in NSCLC due to the above-mentioned reasons. Future prospective trials are needed to aim for larger cohorts and consider additional variables to address the complexities of NSCLC.

ICTs and access to Internet use are considered vital for the achievement of sustainable development goals. So, this study explored the effect of the global digital divide, trade openness, renewable energy consumption, and forestation on greenhouse gas (GHG) emissions in 42 high-income countries (HICs) and high-middle-income (HMICs), low-income countries (LICs), and low-middle-income countries (LMICs) of Africa from 1990 to 2018. TheDumitrescu-Hurlin causality results confirmed a unidirectional causality from GHG emissions to the global digital divide (HICs and HMICs), global digital divide to GHG emissions (LICs), and GHG emission to trade openness (LICs and LMICs). Moreover, the long-run results of the autoregressive distributed lag (ARDL) model showed an increase in GHG due to an increase in the global digital divide in all three panels. Further, ARDL results showed reduced GHG emissions due to increased trade openness in LIC and LMICs, renewable energy consumption, and forestation in all three panels. Thus, to encounter pollution from Internet use, the government should start environment-friendly projects through public and private investment in smart and modern environment-friendly technology and reduce the taxes and tariffs on them. Moreover, the governments of African countries should create public awareness through print and electronic media for raising the forestation area.

Objectives: Rapid innovations in medical science have necessitated the development of an advanced medical curriculum. Taking a step towards this, a temporal integrated system and clinic-pathological conferences themes were introduced in a public sector medical university for fourth year MBBS. This study aims to assess students’ perceptions regarding this change. Methods: A cross sectional study was conducted in a public sector medical university from May 2019 to April 2020. A 17 item pre-validated questionnaire was distributed among all students twice, firstly after completion of first module and then again at the end of the academic year. Results were analyzed using SPSS 21. Results: There were 265 and 176 participants in the first and second phase of the study respectively. Majority of the students agreed that it was easier to study a topic when temporally integrated. Most commonly reported advantage was better understanding and concept of the theme under study. Suggestions included revision of the schedule regarding allocation of time for different topics and implementation of this curriculum from first year MBBS. Conclusion: A small step was taken to make improvements in an old traditional method. Students are adapting to this change as they responded positively to various aspects of this methodology. Continuous feedback, evaluation and amendments will help to improve its effectiveness. doi: https://doi.org/10.12669/pjms.38.3.4732 How to cite this:Shahid R, Ehsan SB, Nawaz M. Introduction of temporal integration in fourth year MBBS curriculum; Students’ experience. Pak J Med Sci. 2022;38(3):---. doi: https://doi.org/10.12669/pjms.38.3.4732 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Background Insomnia has been closely associated with cardiovascular disease (CVD) including myocardial infarction (MI). Our study aims to assess the eligibility of insomnia as a potential risk factor for MI. Methods PubMed, Scopus, and Web of Science were searched using terms; such as “Insomnia” and “MI.” Only observational controlled studies with data on the incidence of MI among insomniacs were included. Revman software version 5.4 was used for the analysis. Results Our pooled analysis showed a significant association between insomnia and the incidence of MI compared with noninsomniacs (relative risk [RR] = 1.69, 95% confidence interval [CI] = 1.41–2.02, p < .00001). Per sleep duration, we detected the highest association between ≤5 h of sleep, and MI incidence compared to 7−8 h of sleep (RR = 1.56, 95% CI = 1.41–1.73). Disorders of initiating and maintaining sleep were associated with increased MI incidence (RR = 1.13, 95% CI = 1.04–1.23, p = .003). However, subgroup analysis of nonrestorative sleep and daytime dysfunction showed an insignificant association with MI among both groups (RR = 1.06, 95% CI = 0.91–1.23, p = .46). Analysis of age, follow‐up duration, sex, and comorbidities showed a significant association in insomniacs. Conclusion Insomnia and ≤5 h of sleep are highly associated with increased incidence of MI; an association comparable to that of other MI risk factors and as such, it should be considered as a risk factor for MI and to be incorporated into MI prevention guidelines.

Some clinical trials reported conflicting results about the efficacy of anterior lateral electrode compared with anterior posterior electrode in electrical cardioversion of atrial fibrillation, and some studies reported no difference in the efficacy between the two procedures. Our aim is to perform a meta-analysis to compare the efficacy of anterior lateral electrode versus anterior posterior electrode in external cardioversion of atrial fibrillation. We searched the following databases: PUBMED, WOS, OVID and SCOPUS. Inclusion criteria were clinical trials that compared anterior lateral electrode with anterior posterior electrode in external cardioversion of atrial fibrillation. We excluded cohort studies, case reports, editorials and animal studies. RevMan software (5.4) was used to perform the meta-analysis. Cardioversion rate outcome was presented as Odds ratios (OR) with 95% confidence interval (CI). After full text screening, 11 trials were included in the analysis. The total number of patients included in the study is 1845. The pooled analysis showed a statistically significant association between anterior lateral electrode and increased cardioversion rate of atrial fibrillation compared with anterior posterior electrode (OR = 1.40, 95% CI = 1.02 to 1.92, p-value = 0.04). We observed no heterogeneity among studies (P= 0.14, I² = 32%). No publication bias was observed. Subgroup analysis revealed a statistically significant association between anterior lateral electrode and increased cardioversion rate of atrial fibrillation compared with anterior posterior electrode in subgroups of less than 5 shocks, patients with 60years-old or more and patients with left atrial diameter > 45 mm (OR= 1.72, 95% CI = 1.17 to 2.54, p value = 0.006), (OR= 1.73, 95% CI = 1.18 to 2.54, p value= 0.005), and (OR= 1.86, 95% CI = 1.04 to 3.34, p value = 0.04), respectively. Our meta-analysis revealed that anterior lateral electrode is more effective than anterior posterior electrode in external cardioversion of atrial fibrillation. Subgroup analysis showed that patients who received less than 5 shocks, patients with 60 years-old or more and patients with left atrial diameter > 45 mm benefit from anterior lateral electrode more than anterior posterior electrode in external cardioversion of atrial fibrillation.

[...]technology innovation remains a weak area for local SMEs, especially small enterprises where technological advancement severely lags. [...]in January 2023 news broke regarding collaboration between Pakistan and China to establish a semiconductor zone in Pakistan, aimed at boosting the chip manufacturing sector. Enhancing support for female entrepreneurship aligns with Sustainable Development Goal 5, pertaining to gender equality and empowerment, fostering socioeconomic development through education, finance, and formal banking channels. [...]to address Pakistan’s distressing labor force participation rate for women, a system that supports female entrepreneurship has to be developed.