Background: Observational studies have suggested that accelerated surgery is associated with improved outcomes in patients with a hip fracture. The HIP ATTACK trial assessed whether accelerated surgery could reduce mortality and major complications. Methods:We randomised 2970 patients from 69 hospitals in 17 countries. Patients with a hip fracture that required surgery and were ≥45 years of age were eligible. Patients were randomly assigned to accelerated surgery (goal of surgery within 6 hours of diagnosis; 1487 patients) or standard care (1483 patients). The co-primary outcomes were 1.) mortality, and 2.) a composite of major complications (i.e., mortality and non-fatal myocardial infarction, stroke, venous thromboembolism, sepsis, pneumonia, life-threatening bleeding, and major bleeding) at 90 days after randomisation. Outcome adjudicators were masked to treatment allocation, and patients were analysed according to the intention-to-treat principle; ClinicalTrials.gov, NCT02027896. Findings:The median time from hip fracture diagnosis to surgery was 6 hours (interquartile range [IQR] 4-9) in the accelerated-surgery group and 24 hours (IQR 10-42) in the standard-care group, p<0.0001. Death occurred in 140 patients (9%) assigned to accelerated surgery and 154 patients (10%) assigned to standard care; hazard ratio (HR) 0.91, 95% CI 0.72-1.14; absolute risk reduction (ARR) 1%, 95% CI -1-3%; p=0.40. The primary composite outcome occurred in 321 patients (22%) randomised to accelerated surgery and 331 patients (22%) randomised to standard care; HR 0.97, 95% CI 0.83-1.13; ARR 1%, 95% CI -2-3%; p=0.71.Interpretation: Among patients with a hip fracture, accelerated surgery did not significantly lower the risk of mortality or a composite of major complications compared to standard care.

BackgroundRice is a drought susceptible crop. A symbiotic association between rice and mycorrhizal fungi could effectively protect the plant against sudden or frequent episodes of drought. Due to its extensive network of hyphae, the endophyte is able to deeply explore the soil and transfer water and minerals to the plant, some of them playing an important role in mitigating the effects of drought stress. Moreover, the endophyte could modify the expression of drought responsive genes and regulate antioxidants.ResultsThree rice genotypes, WC-297 (drought tolerant), Caawa (moderately drought tolerant) and IR-64 (drought susceptible) were inoculated with Piriformospora indica (P. indica), a dynamic endophyte. After 20 days of co-cultivation with the fungus, rice seedlings were subjected to 15% polyethylene glycol-6000 induced osmotic stress. P. indica improved the growth of rice seedlings. It alleviated the destructive effects of the applied osmotic stress. This symbiotic association increased seedling biomass, the uptake of phosphorus and zinc, which are functional elements for rice growth under drought stress. It boosted the chlorophyll fluorescence, increased the production of proline and improved the total antioxidant capacity in leaves. The association with the endophyte also up regulated the activity of the Pyrroline-5-carboxylate synthase (P5CS), which is critical for the synthesis of proline.ConclusionA mycorrhizal association between P. indica and rice seedlings provided a multifaceted protection to rice plants under osmotic stress (− 0.295 MPa).Electronic supplementary materialThe online version of this article (10.1186/s12284-018-0226-1) contains supplementary material, which is available to authorized users.

Climatic variations have increased the occurrence of heat stress during critical growth stages, which negatively affects grain yield in rice. Plants adapt to harsh environments, and particularly high-temperature stress, by regulating their physiological and biochemical processes, which are key tolerance mechanisms. The identification of heat-tolerant rice genotypes and reliable selection indices are crucial for rice improvement programs. Here, we evaluated the response of a rice mutant population for high-temperature stress at the seedling and reproductive stages based on agronomic, physiological and molecular indices. Estimates of variance components revealed significant differences (P &lt; 0.001) among genotypes, treatments and their interactions for almost all traits. The principal component analysis showed significant diversity among genotypes and traits under high-temperature stress. The mutant HTT-121 was identified as the most heat-tolerant mutant with higher grain yield, panicle fertility, cell membrane thermo-stability (CMTS) and antioxidant enzyme levels under heat stress. Various seedling-based morpho-physiological traits (leaf fresh weight, relative water contents, malondialdehyde, CMTS) and biochemical traits (superoxide dismutase, catalase and hydrogen peroxide) explained variations in grain yield that could be used as selection indices for heat tolerance in rice during early growth. Notably, heat-sensitive mutants accumulated reactive oxygen species, reduced catalase activity and upregulated OsSRFP1 expression under heat stress, suggesting their key roles in regulating heat tolerance in rice. The heat-tolerant mutants identified in this study could be used in breeding programs and to develop mapping populations to unravel the underlying genetic architecture for heat-stress adaptability.

Objectives: With the rise in the number of published papers in the biomedical field, plagiarism has become a major ethical concern as it has a direct effect on the quality of these papers. The objective of this research was to determine the perceptions of medical students towards plagiarism, the reasons students engage in plagiarism, the types of plagiarism, the consequences of plagiarism, and solutions to the problem of plagiarism. Methods: This is a cross-sectional study conducted in two medical colleges in Rawalpindi, Pakistan from June to September, 2018, using self-administered structured questionnaires. Results: Of the 1100 participants, up to 86.91% (n=956) were not aware of the existence of plagiarism, but the majority, i.e. 71.18% (n=783) have plagiarised the work of others before. Copying from colleagues or senior students is the most common type of plagiarism that medical students engage in owing to the ease with which fellow students’ work can be shared and copied. However, a lack of institutional awareness of the extent to which plagiarism exists, poor vigilance in detecting it, and the absence of clear policies to deal with plagiarism are mostly to blame. Conclusion: Plagiarism is common among medical students in developing countries, and it is necessary to create awareness about the consequences of engaging in this unethical practice both in the academic field and in the larger medical research society, in order to reduce its prevalence. How to cite this:Javaeed A, Khan AS, Khan SH, Ghauri SK. Perceptions of plagiarism among undergraduate medical students in Rawalpindi, Pakistan. Pak J Med Sci. 2019;35(2):---------. doi: https://doi.org/10.12669/pjms.35.2.33 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.

The management of acid-base disorders always calls for precise diagnosis and treatment of the underlying disease. Sometimes additional means are necessary to combat systemic acidity itself. In this systematic review, we discuss the concept and some specific aspects of bicarbonate therapy for critically ill patients with metabolic acidosis (i.e., patients with blood pH < 7.35). We conducted a systematic literature review of three online databases (PubMed, Google Scholar, and Cochrane) in November 2018 to validate usage of bicarbonate therapy for critically ill patients with metabolic acidosis. Twelve trials and case series were included in the final analysis, from which we assessed population, intervention, comparison, and outcome data. The current literature suggests limited benefit from bicarbonate therapy for patients with severe metabolic acidosis (pH < 7.1 and bicarbonate < 6 mEq/L). However, bicarbonate therapy does yield improvement in survival for patients with accompanying acute kidney injury.

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We present a new approach to the effective development of menu construction systems that allow to automatically construct a menu that is strongly tailored to the individual requirements and food preferences of a client. In hospitals and other health care institutions dietitians develop diets for clients which need to change their eating habits. Many clients have special needs in regards to their medical conditions, cultural backgrounds, or special levels of nutrient requirements for better recovery from diseases or surgery, etc. Existing computer support for this task is insufficientmany diets are not specifically tailored for the client's needs or require substantial time of a dietitian to be manually developed. Our approach is based on case-based reasoning, an artificial intelligence technique that finds increasing entry into industrial practice. Our approach goes beyond the traditional case-based reasoning (CBR) approach by allowing an incremental improvement of the system's competency during routine use of the system. The improvement of the system takes place through a direct expert user-system interaction while the expert is accomplishing their tasks of constructing a diet for a given client. Whenever the system performs unsatisfactorily, the expert will need to modify the system-produced diet 'manually', i.e. by entering the desired modifications into the system. Our implemented system, menu construction using an incremental knowledge acquisition system (MIKAS), asks the expert for simple explanations for each of the manual actions he/she takes and incorporates the explanations automatically into its knowledge base (KB) so that the system will perform these manually conducted actions automatically at the next occasion. We present MIKAS and discuss the results of our case study. While still being a prototype, the senior clinical dietitian involved in our evaluation studies judges the approach to have considerable potential to improve the daily routine of hospital dietitians as well as to improve the average quality of the dietary advice given to patients within the limited available time for dietary consultations. Our approach opens up a new avenue towards building highly specialised CBR systems in a more cost-effective way. Hence, our approach promises to allow a significantly

Salinity is the major threat to global wheat production, particularly in arid and semiarid areas. Breeding salt-tolerant cultivars is one feasible solution, while the presence of genetic variation is a prerequisite for genetic improvement. To detect genetic variation for salt tolerance in wheat, a total of 150 wheat genotypes were tested for seedling-stage tolerance response at 300 mM NaCl in hydroponic culture. Significant differences (P ≤ 0.001) were identified in wheat for seedling traits, and 20 salt-tolerant and 5 susceptible genotypes were selected on the basis of root and shoot weights. These 25 genotypes were tested for salt-tolerance response at the early developmental stage in hydroponic culture at 0, 70, 140, 210, 280, and 350 mM NaCl salinity levels. GGEbiplot analysis was used for measuring salt tolerance for relative growth rates of root length, shoot length, and plant weight.