Neonatal screening for congenital hypothyroidism in Pakistan

Congenital hypothyroidism is a preventable cause of mental retardation. Since clinical signs of congenital hypothyroidism do not generally become obvious before three months of age, screening programmes have been introduced in North America and Europe, which consist of T4 or TSH screening on newborn infants on the third day of life. The screening for congenital hypothyroidism was initiated in Pakistan by the Aga Khan University Hospital (AKUH) in March 1987. By April 1988, 5000 neonates were screened and five cases of congenital hypothyroidism were diagnosed. The study revealed the incidence of hypothyroidism to be one case per 1000 newborns which is about 4 times more than that in the Wes

Helicobacter Pylori Gastritis and risk of Ischaemic Stroke

OBJECTIVE: To identify the association between H. Pylori gastritis and stroke. METHOD: Patients with biopsy proven H. Pylori gastritis and non H. Pylori gastritis were enrolled. Patients were followed for a period of two years. RESULTS: A total of 326 patients were included in the study. 162 patients were with H. Pylori gastritis. There was no significance difference in age, sex and duration of symptoms in the two groups. Three patients in H. Pylori group had stroke or TIA as compared to one in non H. Pylori group. Patients with H. Pylori gastritis were more likely to die or have cardiac and or neurological event as compared to Non H. pylori gastritis (OR 1.23, 95% CI 0.89-1.67). This relationship was not significant after adjusting for cardiovascular risk factors (AOR 0.85, 95% CI 0.45-1.31). CONCLUSION: H. Pylori gastritis is not independently associated with increased risk for stroke. Larger, randomized studies are needed to confirm our findings

Impacts of dividend policy and leverage on the probability of IPO firms to conduct SEOs: survival analysis of Hong Kong listed firms

This study investigates whether Dividend Policy and Leverage are useful indicators to predict whether firms will conduct SEOs in the form of Rights issues and Open offers in Hong Kong. The motivation behind identifying the key factors is to educate investors on how to avoid getting hurt by high wealth transfers and negative abnormal announcement returns associated with rights issues and open offers. Unlike previous studies, this study for the first time includes censored and recurrent event data by applying a discrete-time survival analysis method to determine factors that predict the likelihood of conducting SEOs. The findings of this study demonstrate that proxies of dividend policy and leverage are statistically significant. The results also show that SEOs were conducted by firms in weak financial condition as dividend payout ratio negatively impacted the decision to conduct SEOs, while total debt-to-asset ratio had a positive relationship with the likelihood of conducting SEOs. However, dividend policy is a more useful indicator than leverage to predict whether IPO firms will conduct SEOs because there was a significant difference in dividend payout ratio between IPO firms that conducted SEOs versus IPO firms that did not conduct SEOs throughout the observation period from 2003 to 2020. Whereas the total debt-to-asset ratio did not show a significant difference consistently throughout the entire period. Thus, to avoid monetary losses associated with announcements of rights issues and open offers, investors should avoid investing in firms that are decreasing their dividend payout ratio as they have a high probability of conducting SEOs

How Economic Policy Uncertainty Drives Long-term Industry Beta: Evidence from North America

Purpose: This study aims to evaluate the nature of the relationship between economic policy uncertainty and industry beta and the cross-sectional heterogeneity between them.   Theoretical Framework: Industry Return is derived from the annual market capitalization of each industry by taking a summation of all firms' market capitalization values to find out the industry beta variable. The categorization of 48 industries according to the Fama-French model has been defined as the industry in this study. The main explanatory variable for this research strategy is the Economic Policy Uncertainty or the EPU. Economic policy uncertainty is measured based on the given index by Baker, Bloom, and David index. Baker, Bloom, and Davis, or BBD, perceive that there are different manners by which the economic policy uncertainty can be evolved. For instance, economic policy uncertainty can be influenced by what different types of discussions related to economic policies are going to be undertaken. BBD has tried looking into the landscape regarding the economic policy uncertainty overall through the eyes of newspapers based in the USA. In addition, there has been textual analysis by Baker, Bloom, and Davis or BBD over different types of digital archives for the top 10 U.S. newspapers for obtaining the count of articles on a monthly basis for every newspaper so that they can be able to focus on the specific economic policy uncertainty.   Methodology: Positivist research philosophy has been implicated in conducting this research study. From the research approach perspective, the deductive research approach has been implemented. In addition, a quantitative research strategy has been used for modeling purposes and explanation. Furthermore, an experimental research design has been incorporated into this research strategy. The required data set has been gathered from secondary sources, including the WRDS and BBD databases. Industry return has been calculated based on industry market capitalization. From a modeling perspective, a baseline time series regression model has been incorporated. In this research conduction, there has been an analysis of 10 U.S. industries. The time span is from 2000 to 2020. In addition, there has been an analysis of different policy uncertainties based on the decomposition of EPU.   Results & Conclusion: First, the impact of the economic policy uncertainty in the combined form on the industry-level betas has been analyzed. In this case, the entire time scale of 19 years has been divided into three classes: the financial turmoil period from 2001 to 2006, the financial turmoil period from 2007 to 2010, and finally, the financial turmoil period from 2011 to 2020. It has been pointed out that overall, there has been a statistically significant positive impact of economic policy uncertainty on industry level-betas mostly on all industries. In addition, when there has been a decomposition of the economic policy uncertainty index, a statistically significant positive association has been found regarding monetary policy uncertainty and fiscal policy uncertainty.   Originality: The significance of this research is that there has been a one-to-one relationship finding on the impact of EPU on industry-level beta. Very few literatures have covered this issue broadly. One notable literature on this topic was conducted by Yu et al. in 2017. However, this research study has analyzed another ten industries in North America that have not been previously analyzed. In addition, for deep insight, the research framework has been divided into three parts: overall period analysis, pre-financial crisis turmoil, and post-financial crisis turmoil periods. In addition, there has been an analysis of the impact of component-wise seven policy uncertainty index on industry-level beta.   Contribution: Different factors, including macroeconomic phenomena, can influence industry-level beta or systematic risk. In recent times, economic policy uncertainty analysis has become inevitable for measuring the policy implications and their impacts on industry-level risk to determine their dynamics. The relationship between the economic policy uncertainty index and the industrial structural model of risk dynamics has been established by this research study

Leiomyosarcoma presenting as a spontaneously ruptured renal tumor-case report

BACKGROUND: Ruptured renal neoplasms can be a catastrophic clinical presentation. Angiomyolipoma is the commonest renal tumor which presents in this fashion. Renal sarcomas are rare renal neoplasms. Renal leiomyosarcomas are the most common histological subtype of renal sarcomas, accounting for approximately 50–60% of the reported cases. These tumors are usually peripherally located and appear to arise from either the renal capsule or smooth muscle tissue in the renal pelvic wall. CASE PRESENTATION: A 70 years old male, with hypertension and ischemic disease, developed acute left flank pain. The general physician evaluated this using ultrasound, which showed a solid left renal mass. Two weeks later, he presented in the emergency room in a state of shock with a palpable flank mass. CT scan of the abdomen showed a large heterogeneous mass lesion in the left perinephric space with minimal post contrast enhancement. Per-operatively, large retroperitoneal hematoma was found within Gerota's fascia along with spleen plastered to the upper limit of hematoma. Nephrectomy and splenectomy were performed. Postoperative course was uneventful and patient was discharged on the 10(th )post-operative day. Histopathological evaluation of the specimen showed high-grade leiomyosarcoma CONCLUSIONS: Spontaneous rupture of renal neoplasm is a rare clinical presentation. Angiomyolipoma is the commonest cause of spontaneous rupture of the kidney. Presentation of a leimyosarcoma as a ruptured renal neoplasm has not been previously reported in the English literature

Academic Use of Smartphones in Secondary Level Education in Bangladesh: A Non-Parametric Approach

This study aims to examine the use of smartphones for educational purposes and the acceptance of online learning among secondary students. To investigate the academic utilization of smartphones among secondary students in Bangladesh, a sample of 384 students from different districts of Bangladesh were surveyed. The survey was conducted using a selfadministered, semi-tailored computerized questionnaire. The collected data was analyzed using IBM SPSS statistics 26 and the Mann-Whitney U test. The findings indicate that male students used smartphones for educational purposes with greater confidence and less difficulty than female students. On the other hand, students in 8th to 10th grade classrooms reported a greater willingness to use smartphones for academic purposes, with urban students being more enthusiastic than their rural peers. The study’s findings have implications for the government, policymakers, educators, and non-governmental organizations (NGOs). They highlight the importance of ensuring equal access to resources and tools that support academic success, as well as addressing the adverse effects of excessive smartphone usage. In addition, the government and NGOs should prioritize the elimination of inequities between rural and urban areas and provide subsidies to rural students

Higher entropy observed in SARS-CoV-2 genomes from the first COVID-19 wave in Pakistan

Background: We investigated the genome diversity of SARS-CoV-2 associated with the early COVID-19 period to investigate evolution of the virus in Pakistan.Materials and methods: We studied ninety SARS-CoV-2 strains isolated between March and October 2020. Whole genome sequences from our laboratory and available genomes were used to investigate phylogeny, genetic variantion and mutation rates of SARS-CoV-2 strains in Pakistan. Site specific entropy analysis compared mutation rates between strains isolated before and after June 2020.Results: In March, strains belonging to L, S, V and GH clades were observed but by October, only L and GH strains were present. The highest diversity of clades was present in Sindh and Islamabad Capital Territory and the least in Punjab province. Initial introductions of SARS-CoV-2 GH (B.1.255, B.1) and S (A) clades were associated with overseas travelers. Additionally, GH (B.1.255, B.1, B.1.160, B.1.36), L (B, B.6, B.4), V (B.4) and S (A) clades were transmitted locally. SARS-CoV-2 genomes clustered with global strains except for ten which matched Pakistani isolates. RNA substitution rates were estimated at 5.86 x10-4. The most frequent mutations were 5\u27 UTR 241C \u3e T, Spike glycoprotein D614G, RNA dependent RNA polymerase (RdRp) P4715L and Orf3a Q57H. Strains up until June 2020 exhibited an overall higher mean and site-specific entropy as compared with sequences after June. Relative entropy was higher across GH as compared with GR and L clades. More sites were under selection pressure in GH strains but this was not significant for any particular site.Conclusions: The higher entropy and diversity observed in early pandemic as compared with later strains suggests increasing stability of the genomes in subsequent COVID-19 waves. This would likely lead to the selection of site-specific changes that are advantageous to the virus, as has been currently observed through the pandemic

The Changing Landscape for Stroke\ua0Prevention in AF: Findings From the GLORIA-AF Registry Phase 2

Background GLORIA-AF (Global Registry on Long-Term Oral Antithrombotic Treatment in Patients with Atrial Fibrillation) is a prospective, global registry program describing antithrombotic treatment patterns in patients with newly diagnosed nonvalvular atrial fibrillation at risk of stroke. Phase 2 began when dabigatran, the first non\u2013vitamin K antagonist oral anticoagulant (NOAC), became available. Objectives This study sought to describe phase 2 baseline data and compare these with the pre-NOAC era collected during phase 1. Methods During phase 2, 15,641 consenting patients were enrolled (November 2011 to December 2014); 15,092 were eligible. This pre-specified cross-sectional analysis describes eligible patients\u2019 baseline characteristics. Atrial fibrillation disease characteristics, medical outcomes, and concomitant diseases and medications were collected. Data were analyzed using descriptive statistics. Results Of the total patients, 45.5% were female; median age was 71 (interquartile range: 64, 78) years. Patients were from Europe (47.1%), North America (22.5%), Asia (20.3%), Latin America (6.0%), and the Middle East/Africa (4.0%). Most had high stroke risk (CHA2DS2-VASc [Congestive heart failure, Hypertension, Age  6575 years, Diabetes mellitus, previous Stroke, Vascular disease, Age 65 to 74 years, Sex category] score  652; 86.1%); 13.9% had moderate risk (CHA2DS2-VASc = 1). Overall, 79.9% received oral anticoagulants, of whom 47.6% received NOAC and 32.3% vitamin K antagonists (VKA); 12.1% received antiplatelet agents; 7.8% received no antithrombotic treatment. For comparison, the proportion of phase 1 patients (of N = 1,063 all eligible) prescribed VKA was 32.8%, acetylsalicylic acid 41.7%, and no therapy 20.2%. In Europe in phase 2, treatment with NOAC was more common than VKA (52.3% and 37.8%, respectively); 6.0% of patients received antiplatelet treatment; and 3.8% received no antithrombotic treatment. In North America, 52.1%, 26.2%, and 14.0% of patients received NOAC, VKA, and antiplatelet drugs, respectively; 7.5% received no antithrombotic treatment. NOAC use was less common in Asia (27.7%), where 27.5% of patients received VKA, 25.0% antiplatelet drugs, and 19.8% no antithrombotic treatment. Conclusions The baseline data from GLORIA-AF phase 2 demonstrate that in newly diagnosed nonvalvular atrial fibrillation patients, NOAC have been highly adopted into practice, becoming more frequently prescribed than VKA in Europe and North America. Worldwide, however, a large proportion of patients remain undertreated, particularly in Asia and North America. (Global Registry on Long-Term Oral Antithrombotic Treatment in Patients With Atrial Fibrillation [GLORIA-AF]; NCT01468701

Impacts of dividend policy and leverage on the probability of IPO firms to conduct SEOs: survival analysis of Hong Kong listed firms

This study investigates whether Dividend Policy and Leverage are useful indicators to predict whether firms will conduct SEOs in the form of Rights issues and Open offers in Hong Kong. The motivation behind identifying the key factors is to educate investors on how to avoid getting hurt by high wealth transfers and negative abnormal announcement returns associated with rights issues and open offers. Unlike previous studies, this study for the first time includes censored and recurrent event data by applying a discrete-time survival analysis method to determine factors that predict the likelihood of conducting SEOs. The findings of this study demonstrate that proxies of dividend policy and leverage are statistically significant. The results also show that SEOs were conducted by firms in weak financial condition as dividend payout ratio negatively impacted the decision to conduct SEOs, while total debt-to-asset ratio had a positive relationship with the likelihood of conducting SEOs. However, dividend policy is a more useful indicator than leverage to predict whether IPO firms will conduct SEOs because there was a significant difference in dividend payout ratio between IPO firms that conducted SEOs versus IPO firms that did not conduct SEOs throughout the observation period from 2003 to 2020. Whereas the total debt-to-asset ratio did not show a significant difference consistently throughout the entire period. Thus, to avoid monetary losses associated with announcements of rights issues and open offers, investors should avoid investing in firms that are decreasing their dividend payout ratio as they have a high probability of conducting SEOs