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SummaryThe efficacy of pharyngeal packing in the prevention of postoperative nausea and vomiting (PONV) in patients undergoing nasal surgery was evaluated in a prospective randomised controlled study. The effect of the presence of the pharyngeal pack on the incidence of postoperative sore throat was also assessed. One hundred patients were randomly allocated to one of two groups; the first had packing and the second received no packing. The placement of a pharyngeal pack was found to have no effect on the incidence of PONV but was associated with a significantly increased incidence of sore throat. The absence of a pharyngeal pack was not associated with an increase in postoperative aspiration or vomiting. We conclude that the routine placement of pharyngeal packs during uncomplicated nasal surgery has no effect on the incidence of PONV and will increase the incidence of postoperative sore throat.

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Risk is an inherent part of agricultural production, so farmers often use management strategies to reduce the adverse impacts associated with their activities. Although the use of multiple risk management strategies is common practice in farming, literature on the simultaneous adoption of multiple risk management tools is limited. This study was designed to investigate the impact of various factors on farmers' decisions to adopt on-farm and off-farm diversification and the potential for simultaneous adoption using bivariate and multinomial probit models. The results suggest that the decisions to adopt both on-farm and off-farm diversification are correlated, and adopting one risk management strategy may make it more likely that the other will be adopted simultaneously. Moreover, farm and farm household characteristics, farmers' risk perceptions and their risk attitudes are important factors that shape their risk management adoption decisions.

To determine the mortality of patients with severe COVID-19 in the intensive care unit (ICU) in relation to age, gender, co-morbidities, ventilatory status, and length of stay (LOS). Methods This was a cross-sectional study based on data retrieved for 204 patients admitted to the ICU of Hayatabad Medical Complex, Peshawar, Pakistan, from April to August 2020. Study variables were age, gender, comorbid conditions, ventilatory status, and length of stay (LOS). The data were analyzed using SPSS version 21 (IBM Corp., Armonk, NY). The independent t-test and the chi-square test were used to compare the means and frequencies of variables. Multivariate regression analysis was used to predict the likelihood of mortality. Results The overall mortality was 77%. Non-invasive ventilation (NIV) was administered to 61.8% of patients. Mortality was higher for invasive mechanical ventilation (IMV) (93.6% vs 66.7%, p<0.001) and for over 60 years (87.3% vs 72.3%, p=0.019). Mortality without co-morbidities was 75.2%. Comparative mortality rates for at least one co-morbidity (79.7%), diabetes mellitus (80.0%), hypertension (100%), diabetes mellitus and hypertension both (87.1%), and chronic obstructive pulmonary disease (75%) were insignificant. The LOS for survivors was longer (8.9±8.9 versus 5.4±5.2 days, p=0.017). The LOS < 24h was associated with higher mortality (85.9% vs 72.9%, p=0.040). On multivariable regression, the likelihood of mortality was high for IMV (7.330, 95% CI 2.667-20.143, p<0.001) and elderly (>60 years) patients (2.607, 95%CI 1.063-6.394, p=0.036). Mortality decreased with LOS longer than 24h (0.412, 95%CI 0.173-0.982, p=0.045). Comorbidities did not have any effect on mortality. Conclusions Age more than 60 years and IMV were independent risk factors for higher mortality. Longer ICU stay, specifically more than 24 hours, was associated with lower mortality but LOS less than 24 hours might not have a causal relationship with mortality. The odds of survival were not affected by co-morbidities.

There has been a paucity of research on the experiences of students at Pakistani universities. A survey of over 900 students at two universities examined their approaches to studying and perceptions of their courses. Evidence was obtained for a deep approach, a surface approach and two aspects of a strategic approach. Their perceptions were based upon the instructional practices, the acquisition of generic skills, the appropriateness of the assessment and of their workload, and the available learning resources. A higher-order analysis revealed two broad dimensions of the student experience in Pakistan. Students who had positive perceptions tended to adopt a deep approach, to prefer courses, teaching and assessment that supported their understanding and to be engaged and reliable in their studies. However, students who had negative perceptions tended to adopt a surface approach and to prefer courses, teaching and assessment that reinforced this approach through the bare transmission of information.

Farmers in Pakistan continue to produce maize under various types of risks and adopt several strategies to manage those risks. This study is the first attempt to investigate the factors affecting the concurrent adoption of off-farm income diversification and agricultural credit which the farmers use to manage the risk to maize production. We apply bivariate and multinomial probit approaches to the primary data collected from four districts of Punjab Province in Pakistan. The results show that strong correlations exist between the off-farm diversification and agricultural credit which indicates that the use of one risk management strategy leads to another. The findings demonstrate that education, livestock number, maize farming experience, perceptions of biological risks and risk-averse nature of the growers significantly encourage the adoption of diversification as a risk management tool while farm size inversely affects the adoption of diversification. Similarly, in the adoption equation of credit, maize farming experience, farm size, perceptions of price and biological risks and risk attitude of farmers significantly enhance the chances of adopting agricultural credit to manage farm risks. These findings are important for the relevant stakeholders who seek to offer carefully designed risk minimizing options to the maize farmers.