Dengue fever presenting as quadriparesis due to hypokalaemia: a rare presentation

Dengue is one of the leading causes of arthropod borne viral haemorrhagic fever. Majority of the times, it clinically manifests as fever, arthralgia and rash; however, we present a case of a young man who presented with progressively increasing weakness of all four limbs. Initial investigations showed low potassium, hence he was managed as hypokalaemic periodic paralysis. With initial history of fever and low platelets, dengue was suspected. Dengue antibody was checked which came out to be positive. Potassium was replaced which led to improvement in power of his limbs. He was discharged in a stable condition with a diagnosis of dengue with hypokalaemic quadriparesis

Inter-District Inequalities in Social Service Delivery: A Rationalised Approach towards Funds Disbursement

For a less developed country, Pakistan has experienced a relatively high average per capita growth rate of 2.2 percent, for the period 1950-99 [Easterly (2003)]. Unfortunately, high growth rates have not trickled down sufficiently and the living condition of the general populace leaves a lot to be desired. The UNDP’s Human Development Index (HDI) report released in 2010, ranked Pakistan at 144th on the HDI, out of 178 countries [Wasif (2010)]. The HDI conceptualises poverty to be a multi-dimensional construct and considers adult literacy and life expectancy to be key indicators of the quality of life. Given, that Pakistan has experienced high growth rates but ranks so poorly on the HDI, clearly indicates that despite economic growth, the country faces serious challenges in social service delivery. The coverage of social services is limited and varies across different regions of the country. Easterly (2003) points out that in terms of adult literacy there is a huge variation across provinces and female literacy is only 3 percent in rural Balochistan and Khyber Pakhtunkhwa whereas it is 41 percent in urban Sindh. Zaidi (2005) shows that the situation is not much different in case of health outcomes. The study shows that across the country, nearly half of pregnant women suffer from anaemia and 35 percent of children under age five are malnourished. Moreover, the numbers for infant mortality vary across provinces considerably with urban Punjab having an infant mortality of 70.6 per 1,000 live births compared to the 120.6 of urban Balochistan.

Current Status of Non-Disease Modifying Gene Therapy in Parkinson’s Disease

Parkinson’s disease (PD) is a chronic progressive neurological disorder characterized by bradykinesia, tremor, muscular rigidity, and postural instability. The world-wide prevalence is expected to rise further with increasing mean age. Theoretically, if all desired elements required for dopamine synthesis are functionally available, need for exogenous L-DOPA administration can be eliminated or markedly reduced. However, lack of effective long-term treatment has led to extensive gene therapy research focusing both on disease modifying as well as non-disease modifying aspects. Since genetic lesions are found in both familial as well as sporadic PD cases, the principle of introducing a normal gene to cure a disease can also be applied in PD. Success in effective gene delivery to the target brain regions and its tolerability owing to negligible immune response against the vector has further encouraged the work. The likelihood of gene therapy becoming future and true cure for PD is very high. This commentary describes status of non-disease modifying gene therapy in PD

Corporate Risk Tolerance and Acceptability towards Sustainable Energy Transition

The omnipresence of risk prevails in almost every aspect of human life. Individuals and societal factors are pivotal in the decision-making process to judge acceptability and tolerability of risk. Tolerability of risk (ToR) is characterized by dynamism pinned in the process of decision making that helps to gauge the society and individual’s risk. The energy transition implies switching the energy system from fossil fuels or any traditional mechanism to modern renewable sources that are sustainable. The energy transition is paramount important in the current global energy system to attain sustainable goals for organizations. This study used the positivism research paradigm to address the research questions. The quantitative approach helps to examine the cause-and-effect relationship. It also helps to collect systematic information to meet the objectives of the research. A total sample of 300 was selected for the data collection from renewable energy companies. The study used positivism research philosophy applied deductive approach. The data is analyzed through PLS-SEM. It is summarized that the scale of risk acceptability and tolerability in Pakistan is moderate which encourages companies to work progressively and increases sociocultural activities to make society a partner of this new shift in energy transition that will ultimately increase the level of risk acceptability. Nevertheless, as a society, people are neither high-risk takers nor risk avoiders due to income constraints, macroeconomic uncertainty, and political instability.publishedVersio

Gastroprotective potential and mechanisms of action of Hedera nepalensis

Hedera nepalensis (H. nepalensis) , belonging to the family Araliaceae, is a medicinal plant traditionally used to treat stomach problems. The current study investigated the gastroprotective potential and the mechanism of action of H. nepalensis in diclofenac-and ethanol-induced ulcer models. Anti-oxidant and lipid peroxidation inhibitory prospects of H. nepalensis were checked out by free radical scavenging assay and UV spectrophotometer respectively. Effect of H. nepalensis on the pH, gastric total acidity of gastric juice and protective effects of H. nepalensis against ulcer models have been examined. Histopathological studies have been carried out. The aqueous methanol extract of H. nepalensis (100 µg/mL) showed anti-oxidant (83.55%) and lipid peroxidation inhibitory (70.88%) potential at 1000 µg/mL; the extract had no buffer potential. The extract (400 mg/kg) significantly (81.12% and 63.46%) showed gastroprotective effect in diclofenac and ethanol-induced rat ulcer models respectively. Histopathological studies confirmed the biochemical findings. FTIR analysis showed the presence of carboxylic acid, alkanes, conjugated alkanes, aldehydes and alkyl-aryl ethers. Gallic acid, M-coumaric acid and quercetin were found by HPLC analysis. H. nepalensis exhibited significant protection against diclofenac and ethanol induced gastric damage by anti-oxidant and lipid peroxidation suppression effects suggesting potential broad utility in treatment of diseases characterized with gastric damage

Real-time patient satisfaction of emergency department services in a tertiary-care hospital in Karachi, Pakistan

Background: In Emergency Department (ED), patient satisfaction is an important quality indicator. The aim of this study was to assess the patient satisfaction with ED services using real- time patient satisfaction survey. Methods: The study was conducted for two weeks in the ED of Aga Khan University in December 2011. A structured questionnaire was used to capture patient’s feedback on service quality in the ED. Patient response was recorded using five-level Likert scale; strongly agree, agree, neutral, disagree and strongly disagree. Respondents were either patients or their relatives. Results: Total 348 real-time survey forms were completed. Of these 18.6% (n=61) were in P1 triage category, 32.6% (n=107) in P2 and 48.8% (n=160) were P3 patients. An overall satisfaction rate was 4.27 with satisfactory response from 84.6% patients with ED services. About 87.7% of patients were satisfied with time taken to be attended by the triage staff at the counter, Time taken to get an ED bed was 86.8% and time taken until beginning of treatment after getting an ED bed is 84.3%. Conclusion: Patient satisfaction is an important quality indicator which enables to identify areas of improvement in ED so as to provide better care & services to patients

Posterior Mediastinal Chondrosarcoma- A rare entity

Introduction:Chondrosarcoma is a well defined tumor of soft tissue with calcification. Extraskeletal myxoid chondrosarcoma is an unusual sarcoma of soft tissue adding only 3% to all soft tissue tumors. Majority of mediastinal foci originates from variety of tissues, the reason being their diverse embryological and anatomical approximations. Chondrosarcomas are more common in males with 2:1 male to female ratio. The exact pathology of these tumors is unclear; however recent data ensures that these tumors have multidirectional delineation. Classical histopathological features of chondrosarcoma include S-100 positivity, EMA positivity. These features of Immunohistochemical favor extra skeletal myxoid chondrosarcoma.Case Report:Recent data signifies that the tumor is known for its rare occurrence, here we have reported a unique case of 40 years old male visited Abbasi Shaheed Hospital for pre employment checkup without any symptoms. All the tests were negative except Chest X-ray PA view which revealed dense mass on lower lobe of lung. For further evaluation, CT scan of chest with contrast was ordered and eventually the mass was resected surgically. On the basis of macro and microscopic findings, histopathological tests and immunohistochemical stains, the mass was found to be chondrosarcoma with myxoid origin. This tumor has to be distinguishing among the list of different diseases like hamartoma, hydatid cyst, and neuroendocrine tumors for the differential diagnosis of the case.Conclusion: Our paper reports an extraskeletal mesenchymal chondrosarcoma originating in the posterior mediastinum with a rare presentation.Â

Congenital anomaly of coronary artery: absence of left circumflex artery

The prevalence of congenital coronary artery anomalies is approximately 1% in the general population. They are a common cause of sudden death in younger persons. Congenital absence of the left circumflex artery is usually a benign condition but can cause symptoms of exertional angina. We present a case of a 59-year-old female who presented with complaints of chest pain. She was evaluated by the cardiology service. An invasive angiogram identified the absence of the circumflex artery, a large right coronary artery, and large septal and diagonal branches of the left main coronary artery possibly as a compensatory mechanism to supply blood to the LCx territories. It is important to define coronary anatomy as anomalies dictate which cardiac intervention should be attempted in cases of ischemia