Interrelationships between capital structure and financial performance, firm size and growth: comparison of industrial sector in KSE

The purpose of the Study is to explore relationship between the capital structure and financial performance, evidence from 21 industries in Karachi stock exchange in Pakistan. The study has been analyzed capital structure and its impact on financial performance during year 2004 to 2008. (5 years) financial years of 21 industries in KSE. The study will empirically investigate the relationship between the capital structure and financial performance, by using correlation and regression test on financial data which is collected from analysis reports of KSE, Balance sheet analysis and financial statements of 21 sectors. The results have several Significant implications. The findings of the study show a positive relationship between the  Leverage, financial performance and Growth, Size, of the companies by accepting the alternate hypothesis H 1 and Ho is rejected. Key Words: leverage, Financial Performance Size, Growt

Zinc Supplementation in Children with Acute Diarrhea

Background: To evaluate the effect of zinc supplementation on the outcome of acute diarrhea by comparing it with standard management of acute diarrhea in children. Methods: In this interventional study, total 100 patients, 6 months to 5 years of age were enrolled and were randomly allocated in Group A or Group B . Group A was treated with standard management of acute diarrhoea whereas Group B was given zinc supplementation in addition to standard management protocols. Children were monitored for stool frequency, consistency , state of hydration and any complicating factor. Results: The frequency of stools in group A and B reduced from 16.1 + 4.4 8 stools/day and 15.66+ 4.24 stools/day to 6.80+ 1.99 stools/day and 1.78+ 1.79 stools/day respectively. The consistency of stools in group A and B changed from 3.9 and 3.8 on day one to 2.14 and 1.68 , respectively , on day 7. Conclusion: The zinc supplementation had no effect on the outcome of acute diarrhoea in children. There was no significant reduction in the severity of acute diarrhoea in the children who were given the zinc supplements, in comparison to those who were managed with the standard treatment protocol

Rota Virus Gastroenteritis in Children Upto Five years of Age

Background: To estimate the proportion and peak age of rotavirus diarrhoea among children of age two months to five years Methods: In this descriptive study five hundred patients with acute watery diarrhoea (AWD) were screened for rotavirus. Stool sample of about 5 ml was taken & tested in the laboratory for group A rotavirus antigen by Enzyme immunoassays (EIA). Results: Mean age of patients with AWD was 12.5 months . Out of 500 patients 147 ( 29.4%) were positive for group A rotavirus. Majority of positive patients 116/147 (78.9%) were in the age group 2 months to 12 months. Conclusions: As there are many types of rotavirus i.e. A, B, C, D, and E so overall burden for all serotypes will be much higher. Rotavirus vaccine is an effective preventive measure available against rotavirus diarrhe

Relationship between Financial Leverage and Financial Performance: Evidence from Fuel & Energy Sector of Pakistan

Fuel and energy sector serves as the backbone of the economy. The segment provides support, not only for the economic development of the country by showing positive trends towards the sectoral growth, but also serves as a steering wheel for the growth of manufacturing, trading and service sector. It provides significant inputs for production, trade and service. A general concept prevails that the financial leverage is helpful to enhance the financial performance of the companies. For measuring the impact of financial leverage on the financial health of the companies, it is essential to know whether a positive relationship exists between the financial leverage and financial performance or not? So, this study is intended to test the hypothesis and to measure a relationship between the financial leverage and the financial performance of the fuel and energy sector in Pakistan. The paper also examines the generalization that firms with higher profitability may choose high leverage by using various statistical tools. The findings of the study show a positive relationship between the financial leverage and the financial performance of the companies by accepting the alternate hypothesis H1 and Ho is rejected. The results of the study confirm that the firms having higher profitability may improve their financial performance by having high levels of financial leverage. The study provides evidence by evaluating different facts. It reveals that the players of the fuel and energy in Pakistan can improve at their financial performance by employing the financial leverage and can arrive at a sustainable future growth by making vital decisions about the choice of their optimal capital structure.   Key Words: Financial leverage, Firms’ Performance, Key Indicators- Financial Ratios, Fuel and Energy Sector in Pakistan

Effect of early tranexamic acid administration on mortality, hysterectomy, and other morbidities in women with post-partum haemorrhage (WOMAN): an international, randomised, double-blind, placebo-controlled trial

Background Post-partum haemorrhage is the leading cause of maternal death worldwide. Early administration of tranexamic acid reduces deaths due to bleeding in trauma patients. We aimed to assess the effects of early administration of tranexamic acid on death, hysterectomy, and other relevant outcomes in women with post-partum haemorrhage. Methods In this randomised, double-blind, placebo-controlled trial, we recruited women aged 16 years and older with a clinical diagnosis of post-partum haemorrhage after a vaginal birth or caesarean section from 193 hospitals in 21 countries. We randomly assigned women to receive either 1 g intravenous tranexamic acid or matching placebo in addition to usual care. If bleeding continued after 30 min, or stopped and restarted within 24 h of the first dose, a second dose of 1 g of tranexamic acid or placebo could be given. Patients were assigned by selection of a numbered treatment pack from a box containing eight numbered packs that were identical apart from the pack number. Participants, care givers, and those assessing outcomes were masked to allocation. We originally planned to enrol 15 000 women with a composite primary endpoint of death from all-causes or hysterectomy within 42 days of giving birth. However, during the trial it became apparent that the decision to conduct a hysterectomy was often made at the same time as randomisation. Although tranexamic acid could influence the risk of death in these cases, it could not affect the risk of hysterectomy. We therefore increased the sample size from 15 000 to 20 000 women in order to estimate the effect of tranexamic acid on the risk of death from post-partum haemorrhage. All analyses were done on an intention-to-treat basis. This trial is registered with ISRCTN76912190 (Dec 8, 2008); ClinicalTrials.gov, number NCT00872469; and PACTR201007000192283. Findings Between March, 2010, and April, 2016, 20 060 women were enrolled and randomly assigned to receive tranexamic acid (n=10 051) or placebo (n=10 009), of whom 10 036 and 9985, respectively, were included in the analysis. Death due to bleeding was significantly reduced in women given tranexamic acid (155 [1·5%] of 10 036 patients vs 191 [1·9%] of 9985 in the placebo group, risk ratio [RR] 0·81, 95% CI 0·65–1·00; p=0·045), especially in women given treatment within 3 h of giving birth (89 [1·2%] in the tranexamic acid group vs 127 [1·7%] in the placebo group, RR 0·69, 95% CI 0·52–0·91; p=0·008). All other causes of death did not differ significantly by group. Hysterectomy was not reduced with tranexamic acid (358 [3·6%] patients in the tranexamic acid group vs 351 [3·5%] in the placebo group, RR 1·02, 95% CI 0·88–1·07; p=0·84). The composite primary endpoint of death from all causes or hysterectomy was not reduced with tranexamic acid (534 [5·3%] deaths or hysterectomies in the tranexamic acid group vs 546 [5·5%] in the placebo group, RR 0·97, 95% CI 0·87-1·09; p=0·65). Adverse events (including thromboembolic events) did not differ significantly in the tranexamic acid versus placebo group. Interpretation Tranexamic acid reduces death due to bleeding in women with post-partum haemorrhage with no adverse effects. When used as a treatment for postpartum haemorrhage, tranexamic acid should be given as soon as possible after bleeding onset. Funding London School of Hygiene & Tropical Medicine, Pfizer, UK Department of Health, Wellcome Trust, and Bill & Melinda Gates Foundation

Effects of Diabetogenic Agent Streptozotocin on Hematological Parameters of Wistar Albino Rats "An Experimental Study"

Background: Diabetes mellitus has remained the major concern for medical sciences researches due to its deleterious effects on general, physical and mental health of patients. To understand the pathophysiology and to explore better treatment options for such kind of metabolic disorders it is necessary to generate the experimental animal models. To create diabetic animal models, streptozotocin has shown predominance in selectivity as a diabetogenic agent. While studying effects of any intervention in the diabetic animal models, being a cytotoxic drug streptozotocin may affect the study results by inhibiting highly replicating cells especially hematopoietic cells. Keywords: Streptozotocin; animal model; hematological parameters. 1. INTRODUCTION Diabetes mellitus has remained the major concern for medical sciences researches not only due to its high incidence and prevalence rate but also due its deleterious effects on general, physical and mental health of the patients [1]. To understand the pathophysiology and to explore better treatment options for such kind of metabolic disorders it is necessary to generate the experimental animal models [2]. To create diabetic animal models, surgical (pancreatectomy) and pharmacological (alloxan monohydrate and streptozotocin) options have been used in research but pharmacological options particularly use of streptozotocin has shown predominance in selectivity as a diabetogenic agent [1,2]. Chemically, streptozotocin is a derivative of synthetic Nitrosoureido Glucopyranose and has been used for cancer chemotherapies [3], being its potential to inhibit DNA synthesis in bacterial and mammalian cells [4]. While its diabetogenic effect is thought to be attributed to its ability to cause pancreatic β cells’ death by DNA alkylation and hence used to induce diabetes mellitus in experimental animals [5,6]. The methods to induce diabetes in animal models by streptozotocin fall under three categories 1. Multiple small doses (i.e. 40 mg/kg) of streptozotocin over a period of several days 2. A single moderate dose (i.e. 60 mg/kg) of streptozotocin or 3. A single large dose (100 mg/kg) of streptozotocin produce diabetes in 48- 72 hours. Usually a single large dose of streptozotocin is used to induce diabetes in experimental models as reported by Ito et al. 100 mg / kg of streptozotocin produced non-insulin dependent diabetes mellitus in experimental animals [7]. Streptozotocin can be administered by various routes including subcutaneous and intramuscular routes but intraperitoneal and intravenous administration routes are preferred. [8]. After 3-4 days of streptozotocin administration fasting blood glucose levels are obtained to confirm the accuracy of procedure [9] and on 5th day when 180-500 mg/dl serum glucose levels are obtained experimental animals are considered as diabetic [10]. Though streptozotocin is preferred pharmaco- logical method for induction of diabetes [11], many studies have reported spontaneous recovery from hyperglycemia due to reactive hyperinsulinemia insulinoma [12,13,14]. Streptototozin, not only affects pancreas and cause diabetes in experimental animals but also have a potential to produce toxic effects on other body tissues as well. It has been learnt through a number of studies that streptozotocin is associated with high incidence of hepatic and renal tumors [15], increase in permeability of blood brain barrier [16], renal hypertrophy [17] and retinal damage in experimental animal models [18]. As already discussed that streptozotocin damages DNA by alkylation and produces free radicals, therefore it may harm any organ system of animals [19]. Despite of aforementioned, streptozotocin is still employed Aims: The aim of study was to analyze the effects of streptozotocin on various cellular components of blood such as RBCs, WBCs (Lymphocytes, Neutrophils, Eosinophils), Hb%, HCT and Platelets, at baseline, 5th day and 15th day without any intervention. Study Design: Animal based Experimental study. Place and duration of Study: The study was conducted at animal house of faculty of Pharmacy Ziauddin University Karachi, while laboratory work was performed at MDRL-1 Ziauddin University. Methodology: In Group A normal saline and in group B and C 60 mg / kg streptozotocin diluted in normal saline was administered intraperitoneally. After the confirmation of induction of Diabetes in rats, on fifth day blood samples were drawn from Group A and B and were analyzed. While blood samples from group C were drawn on fifteenth day. Results: Analysis of various hematological parameters on 5th day revealed that there was a decrease in the levels of Hb, HCT, RBCs and WBCs with an increase in platelet count in group B in comparison to group A (control). On the other hand, in Group C (15th day), blood cell counts (Hb, HCT, RBCs, WBCs, Lymphocytes, Neutrophils and platelets) seemed to recover from streptozotocin induced decline that was observed in group B, however did not reach the baselines as in group A(control). Conclusion: It is concluded that change in hematological parameters of rats after administration of streptozotocin is reversible. The blood parameters may recover near to base line values without any intervention within two weeks

Association of Depression, Anxiety and Stress in Medical Students Studying in Modular, Semester and Annual Examination System

Background: When there are high demands besides less resources, a person experiences a feeling of fear that is known as “Stress”. Students of professional schools/colleges and universities are encounter more stress than the general population as they are in a transitory phase from adolescence to adulthood. It has been highlighted that medical education has greater association with stress. There are three examination systems that are been followed by medical colleges of Pakistan (modular, semester and annual systems). However, to the best of our knowledge, no data is available to show the association of stress with current examination systems in our country. Aims: The objectives of our study were to find out the association of stress with different examination systems and to identify the frequency of stress causing and coping factors adopted by 1st, 2nd and 3rd year medical students studying in colleges having different examination systems i.e. modular, semester and annual. Study Design: Comparative cross-sectional study. Place & Duration of Study: This study was conducted from December 2018 to April 2019 in three medical colleges of Sindh having above mentioned examination systems. Study Population: Medical students of 1st 2nd and 3rd year. Methodology: To assess depression, anxiety and stress among study population, DASS Scale was used. To identify the stress causing and coping factors in the students Likert scale based proforma with 19 factors were given to the selected participants Results: There was no significant association of examination system with depression, anxiety and stress, however various stress causing and coping factors were found significant in altering medical student`s life. Conclusion: According to our study, the frequency of stress in the medial students has no association with the examination systems (modular, semester and annual), currently followed by the medical colleges in Sindh, Pakistan