Imam Nasafi and his Book "Kanz al-Daqayq": Introduction and Methododology

Imam Nasafi was a famous jurist and religious scholar from the province of Iran. The famous Hanafi scholar Imam Nasafi was born in Khuzestan around 610 AH and died in 710 AH. He wrote several scholarly books and especially Kunz-ud-Daqeeq gained fame in textual jurisprudence. In this article, the biography of Imam Nasafi and his famous text on jurisprudence, method of the Kunz al-Daqayq, will be discussed. In his book, Allama Nasfi has derived all the problems from Imam Muhammad's "Al-Jaami al-Saghir", "Al-Jaami al-Kabir" and "Ziyadat". But the excellence and eloquence of the word has been maintained. In this book, there is a collection of about 40,000 jurisprudential problems

A Case of Pneumomediastinum and Pneumoperitoneum with Concurrent Massive Subcutaneous Emphysema due to Repositioning of a Tracheostomy Tube.

Tracheostomy is a common procedure seen in critically ill patients that require long term ventilatory support. As with all airway access procedures, tracheotomy with prolonged tracheal tube placement comes with possible risks such as tracheal scarring, tracheal rupture, pneumothorax, tracheoesophageal fistula among others. Another possible complication, though rare, is escape of free air into the surrounding tissue, as well as pneumomediastinum (PM). This may occur due to various reasons, some of them being tracheal rupture, barotrauma or tracheal tube mispositioning. Pneumomediastinum may present with concurrent free air in other body cavities such as the peritoneum, thorax or subcutaneous tissue. Though often not life-threatening it may require treatment including high flow oxygen, ventilator management or occasionally, surgical intervention. Herein we describe a rare case of PM with communicating pneumoperitoneum and massive subcutaneous emphysema due to tracheal tube mispositioning along with a review of the literature

Residents’ Perception Of Surgical Theatre Educational Environment At Public Hospitals Of Rawalpindi - A Steem Survey

INTRODUCTION: The experience in the operation theatres is pivotal for surgical education. A measure of the educational environment in the operating room as perceived by residents would assist educators and trainees in gauging the quality of the learning occurring within their institute.     METHODS:  A cross-sectional survey using the surgical theatre educational environment measure (STEEM) 40-item inventory to measure theatre learning environment perception of surgery and allied residents in public sector hospitals of Rawalpindi. Internal reliability of the inventory was assessed using the Cronbach α coefficient. P≤ 0.05 was considered significant.   RESULTS:  107 respondents were included in the study. Mean score of the survey was 133.7± 20.2. No significant differences in perception were found among residents at different stages and gender, except in learning subscale of the inventory for both gender and residents and the teaching and training subscale among residents at different levels. The inventory showed a high internal consistency with a Cronbach α of 0.851.   CONCLUSION: Surgical training and education have still a long way to go in the public sector. Much needed collaborations with education specialist and senior surgeons is required. Interval collection of feedback and perceptions of the educational environment is also necessary

Highly efficient maximum power point tracking control technique for PV system under dynamic operating conditions

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A matched case-control study of risk factors for neonatal tetanus in Karachi, Pakistan

Background: Previous studies have identified various risk factors for neonatal tetanus (NNT) in rural areas of Pakistan. The present matched case control study was conducted to further evaluate these risk factors in an urban setting. Aim: The study was carried out to identify risk factors for NNT in Karachi. Materials and Methods: Patients of NNT (n = 125) diagnosed from January 1998 to February 2001 were recruited through a surveillance system of Expanded Programme on Immunization (EPI). Two neighbourhood controls (n = 250) were matched for each case for gender and date of birth of the case. Statistical Analysis: Conditional logistic regression was performed to assess the independent effect of factors associated with NNT. Results: The final multivariable model identified subsequent application of substances on the umbilical cord (adjusted matched odds ratio [adj. mOR] = 5.1 [2.7-9.7]), home delivery (adj. mOR = 1.8; 95% CI: 1.1- 3.1) and illiterate mother (adj. mOR = 1.6; 95% CI: 1.0- 2.0) as risk factors for NNT after adjusting for other variables in the model. Population attributable risk per cent (PAR %) for subsequent cord application was 69% and PAR % for home delivery was 31%. Conclusion: Health planners, while formulating control strategies through immunization programmes should also take into account the impact of post-delivery practices, such as 'subsequent cord application' along with pre-delivery practices. Health awareness regarding appropriate post-delivery practices should be promoted and counselling of pregnant women for giving preference to health care setting for delivery is also crucial

Quality of life in individuals surgically treated for congenital hydrocephalus during infancy: A single-institution experience

Background: Congenital hydrocephalus (CH) is a frequently encountered birth anomaly that can hinder long-term neurologic maturity and social well-being of affected children. This study was undertaken to assess quality of life (QOL) 10-15 years after surgical treatment for primary CH during infancy at a tertiary care hospital in a developing country.Methods: This retrospective cohort study included individuals who presented to Aga Khan University Hospital, Karachi, Pakistan, between 1995 and 2005 at QOL.Results: Of 118 patients, 90 patients participated in the study. Mean age at first admission was 6.2 months. Mean length of follow-up was 5.4 years. Of these, 28 patients had died after surgery. Shunt infection (P = 0.012) and delayed milestones (P = 0.003) were found to be statistically significant factors affecting mortality in the patients who died. The mean overall health score was 0.67 ± 0.30. Age (P = 0.039).Conclusions: In our analysis, we assessed the QOL associated with CH. We hope that these results will provide insight for future prospective work with the ultimate goal of improving long-term QOL in children with CH

Effects of Hepatitis C on Hematological Parameters in local areas of Mirpurkhas

Introduction: Various diseases have emerged as a major cause of morbidity and mortality in patients with human immunodeficiency virus (HIV) and hepatitis B virus (HCV) confection, now that antiretroviral therapies become more effective e and has prolonged life expectancy in HIV-infected patients1. One of the most frequently identified extra-hepatic abnormalities often seen at the time of diagnosis of HIV is the hematological abnormalityObjective: To determine possible effects of Hepatitis C in local Population of MirpurkhasMethodology:140 diagnosed patients of Hepatitis C were selected from OPD/Ward MMCH and Civil Hospital Mirpurkhas, Patients of Hypertension, Heart Failure, Renal diseases and respiratory disease were excluded Their ALT, GGT, Alk Sodium was determined by kit method. Their RBC count, TLC, Platelet Count was counted and ESR was determinedResults: It was a prospective study and out of 140 hepatitis C patients 86 were male and 54 were female. The mean age was 54.77 ± 14.046 years. The mean height was 159.42 ± 11.188 cm and the mean weight was 53.69±10.604 Kgs. The mean BMI was calculated as 21.235 ± 5.0607 kgs/m2 (Table.1). The mean Hemoglobin was estimated as 10.639± 2.6924 gm% the mean RBC count was found 3.832 ± .8460 millions/cmm. The mean total leukocyte count was 9111.63 ± 4612.845 per cmm and the mean Platelet count was 160447.67 ± 93788.194 /dl. the mean ESR was 51.70 ± 26.320 (Table.2) The mean Alkaline phosphatase was 273.76± 96.818 IU, the mean GGT was 83.40 ± 102.650 IU and the mean ALT was 74.98 ± 58.614 IU. (Table.3.) The Correlation of hepatitis C was estimated by Pearson’s correlation using SPSS 15 and found that hepatitis has a significant correlation with Hemoglobin, RBC count, TLC and Platelet count (r=.167, .165, .181, 238 and p=.092̽*, .031*, 018* and .002** respectively) and it has an inverse correlation with ESR (r=-.213, p=.005**)Conclusion: Our data shows that hepatitis C has positive correlation with Hb, RBC Count, TLC and Platelet count while the hepatitis has a significant inverse correlation with ESR. More work is required to establish criteria regarding correlation between Hepatitis C and Hematological parameter

ROLE OF SONOELASTOGRAPHY IN THE EVALUATION OF THYROID NODULES

Thyroid nodular disease is one of the most common endocrine disorder. B mode ultrasound provides useful characteristic information about thyroid nodules but it has noticeably low accuracy to differentiate benign from malignant. Fine needle aspiration is widely been used in differentiation of benign and malignant thyroid nodules but it is an invasive procedure. Sonoelastography is a newly developed non- invasive technique which uses ultrasound and gives information about the stiffness of tissue. It estimates the hardness of thyroid lesions in association with adjacent tissues and assists in the differentiation of benign from malignant nodules.Objective:The objective of this study was to evaluate the role sonoelastography in the evaluation of thyroid nodules. Methods:This study was conducted on 72 Patients of age between 18-80 years of either gender at Institute of Nuclear Medicine and Oncology Lahore (INMOL) Pakistan, from 25 March 2019 to 23 August 2019 for duration of five months. Elastography was performed using Toshiba Aplio 500.  Patient having one or more solid nodules in thyroid on conventional ultrasound examination were included in the study and the sonoelastography of nodules was confirmed with histopathological findings of nodules. Results: A total 72 participants were included in our study. The mean age of participants was 42.11 years. Gender distribution shows that 51.4% (n=37) were male and 48.6% (n=35) were female. Sonoelastographic strain ratio of 55.6% nodules (n=40) was more than 2.1(malignant feature) and 44.4% nodules (n=32) have less than 2.1 (benign). Histopathology showed 56.9% of participants (n=41) have malignant nodules and 43.1% (n=31) have benign nodules. The comparison of sonoelastography and histopathology in reference with nodules shows that the results of histopathology and sonoelastography were same and support each other. Conclusion: Sonoelastography is non-invasive and cost-effective imaging technique to diagnose thyroid nodules either benign or malignant. Keywords: Ultrasound Elastography, Thyroid Nodules, Benign, Malignant, Fine Needle Aspiration. DOI: 10.7176/JHMN/66-08 Publication date:September 30th 201

Assessment of Human Health Risk of Zinc and Lead by Consuming Food Crops Supplied with Excessive Fertilizers

For the study of heavy metals impact on human beings, areas in Sargodha city that were supplied with various types of fertilizers were chosen. The three industrial areas; (Bhalwal, Sillanwali, and Sahiwal) of this city were explored for research reasons. The researchers wanted to know how much heavy metal was in the soil, food crops, and human. Excess fertilizer use contributes to global pollution. Farmyard manure, urea, and potassium chloride were used on Site 1; urea phosphate, manure, and ammonium sulphate were used on Site 2; and super phosphate, ammonium phosphate, and nitrate phosphate were used on Site 3. Samples of commonly used food crops, their respective soils and blood of residents who ingested the food crops of the studied area were collected. The zinc and lead levels in soil (8.30-16.80 and 1.80-12.71 mg/kg) and food crops (0.26-2.02 and 2.26-4.70 mg/kg) were far lower than WHO permitted limits. Blood mean concentration of both Zn (2.30-4.30 mg/L) and Ni (0.24-0.70 mg/L) were found maximum in residents of Site 3. The values of pollution load index, bioconcentration factor, enrichment factor for both zinc and lead were (0.18-0.37 and0.220-0.948), (0.027-0.138 and 0.316-1.705), (0.020-0.144 and 0.515-2.780), respectively. Daily intake of metal (0.004-0.008 and 0.001-0.002 mg/kg/day) and health risk index (0.0001-0.016 and 0.005-0.115) values were observed to be lower in individuals for Zn and Pb, respectively. In present work values of all pollution indices wereSo, there would be no human health hazard

Effects of Fertilizers on Copper and Nickel Accumulation and Human Health Risk Assessment of Vegetables and Food Crops

Despite the fact that fertilizers have been used for millennia for sustainable crop production, this high and considerable dependence on fertilizers heightens environmental concerns with the indirect human exposure due to accumulation of toxins in food chain via soil contamination. The purpose of this study is to evaluate the application of fertilizers to the soil and their effect on the accumulation of copper and nickel in spinach (Spinacia oleracea), garlic (Allium sativum), wheat (Triticum aestivum), maize (Zea mays), and barley (Hordeum vulgare); as well as potential health concerns associated with consuming vegetables cultivated on this contaminated land. Samples of available soil, food crops, and human blood were collected from three different Tehsils: Bhalwal, Sahiwal, and Silanwali and were regarded as site 1, site 2 and site 3 respectively. Urea, farmyard manure, and potassium chloride were delivered to Site 1; urea phosphate, manure, and ammonium sulphate were delivered to Site 2; and superphosphate, ammonium phosphate, and nitrate phosphate were delivered to Site 3. Data was subjected to statistical analysis for computing out ANOVA and correlation. Analysis revealed that minimum copper concentration was found in the soil of T. aestivum grown at Site-1 while the inhabitants of Site 3 had the highest concentration of Cu in their blood. The highest level of HIR was found in the human beings that ate the S. oleracea grown at Site 3. It is strongly advised that fertilizers be used sparingly, as their excessive use can cause human health risks