Pattern of Head Injury and Recovery in First and Second Rider in Motor Bike Accidents

To compare the rate and pattern ofhead injury sustained by the first vs. second riderand mortality rate and functional outcome of the twogroups.Methods: In this cross sectional study all adultpatients presenting with head injury resulting froma motorcycle accident, during the study period wereenrolled.Proforma’s were filled by the on-dutydoctor, including the demographic details, detailsregarding helmet and first or second rider,neurological status, additional injuries andradiological pattern of injury. These patients weredivided into two groups: Group-1 (First riders) andGroup-2 (Second riders) and both groups werecompared for the above details, and followed. Allpatients received the standard treatment for theirrespective injuries and the two groups werecompared for the mortality and neurological andfunctional outcome, assessed by using the ExtendedGlascow Outcome Scale. (EGOS).Results: A total of 360 patients were included in thestudy. Of these,65% patients were in group-1 and35% were in group-2. The mean age of the twogroups was 27.86 and 30.12 years respectively. Allpatients in group-1 were males while 61.9% ingroup-2 were males. Majority of the riders in bothgroups were not wearing helmets at the time ofaccident. Major injury in both the groups was facialinjury but the frequency of facial injury wassignificantly higher in group-1 as compared togroup-2 i.e. 20.5% vs. 11.9% (p = 0.040). CT brainshowed normal scan in 15.4% patients in group-1and in 2.4% patients in group-2. In group-1, CT brainshowed highest frequency of traumatic braincontusions (24.4%) followed by Extraduralhematomas (14.1%) and cranium fracture (12.8%). Ingroup-2, CT brain showed highest frequency oftraumatic brain contusions (35.7%) followed bycranium fracture (16.7%), ASDH (9.5%) and TSAH(9.5%). Complete recovery was significantly higherin group-1 as compared to group-2 (p = 0.011).Conclusion: In motor bike riding head injury is apotential threat not only to the 1st rider but also tothe 2nd rider as well. By using helmets head injury,which is fatal in most of the instances, can beavoided

Impact of Organizational Resistance to Change on BPR Implementation: A Case of State Bank of Pakistan

The purpose of this research study is to find the impact of organizational resistance to change on BPR implementation. This paper proposed that Human related factors, Organization related factors and IT training are responsible for explaining the organizational resistance and have a positive impact on the success of BPR implementation. A questionnaire survey is conducted in the State Bank of Pakistan where BPR is done. The results have shown that explanatory factors influence the BPR implementation up to 65.7% and have a significant and positive impact on the latter. When the human related factors and organizational factors are taken care of, and proper IT training is given to the employees, it helps the organization to manage any resistance coming up with a change process, and hence it results in the successful implementation of BPR. Keywords: Business Process Reengineering, Organizational Resistance, Change, Organization Related Factors, Human Related Factors, IT Training.

ALUATION OF MUTUAL FUNDS AND SELECTION ABILITIES OF FUND MANAGERS IN PAKISTAN

Mutual funds are decent tools to encourage savings andinvestments, especially in developing nations like Pakistan whichrely heavily on foreign aids. This study explores the mutual fundperformance in Pakistan by using seven different performancemeasures, i.e. Sharpe, Treynor, Sortino, Information, Jensen Alpha,M2/RAP, Fama decomposition measures. This study covers a periodranging from July 2005 to June 2013 and includes 27 mutual fundschemes out of which 20 funds are open ended while 07 funds areclosed ended. Results prove underperformance on the part of all themutual funds and the whole industry was found weak on the part ofthe selection abilities of the fund managers and the portfolios werefound less diversified. However, it was noticed that closed ended fundsare better performers as compared to the open ended funds. Resultswere also inconsistent for the performance of individual funds asnone of the funds had the same rankings with respect to all the measuresused

Phytochemical and cytotoxic analysis of Pharthenium hysterophosis selected from District Bannu, Pakistan

Parthenium hysterophorus is a well known medicinal plant widely used traditionally in the treatment of various diseases and as a constituent of various drugs, and in phytotherapy. The current study was designed to investigate the phytochemical screening and cytotoxic capacity of methanolic and n-hexane extract of P. hysterophorus. Quantitative analysis of P. hysterophorus showed maximum quantity of flavonoids in methanolic extract of P. hysterophorus which turned down gradually in n-hexane extract of P. hysterophorus due to the decrease in organic solvents polarity. Similar results were also observed for saponins and tannins during this investigation. The highest quantity of alkaloids was recorded in the methanolic extract of P. hysterophorus when compared to n-hexane extract. The extracts also showed maximum cytotoxic potential in various concentrations of n-hexane and methanolic extract of P. hysterophorus. The results revealed that P. hysterophorus contains a remarkable cytotoxic activity due to the presence of bioactive constituents.Key words: Parthenium hysterophorus, cytotoxic, phytochemical screening

Introduction of emergency contraceptive pills (ECPs) through lady health workers (LHWs) program in Pakistan: Findings of an evaluation study

This report documents the findings from a five-day study tour of Pakistani officials to Bangladesh, organized by the Population Council, to afford an opportunity for representatives of both the Ministry of Health and Population Welfare to learn from the experience of Bangladesh in introducing emergency contraceptive pills (ECPs) through their National Public Health System. One of the recommendations was to enhance the availability of emergency contraception in Pakistan by making it available through outlets of the health system, especially through the network of the community-based Lady Health Workers (LHWs). There is a high unmet need for ECP in LHW areas, therefore, it is recommended that the ECP program be scaled up throughout the country in a phased manner. There is need for supportive monitoring and supervision of the program as well as the use of mass media to improve awareness of the option

Modeling Wastewater Evolution and Management Options under Variable Land Use Scenarios

The development of a reliable decision support system and predictions for water quantity and quality often require a reasonable level of environmental and hydrological simulations at various geographic scales. The Soil and Water Assessment Tool (SWAT) model offers distributed parameter and continuous time simulation, and flexible watershed configuration and with the adoption of geographic information system (GIS) technology, a user-friendly and interactive decision support system can be developed for wastewater management. In this chapter, we evaluated the spatio-temporal evolution of wastewater contaminants in an environmentally degraded watershed through integrated field-based investigations and modeling approach. Later, management options were identified to improve the watershed health and agro-environment. The results of the modeling study exhibited variable responses of surface runoff and water quality to different scenarios of land use change. Temporal wastewater analysis indicated a significant impact of seasonality on the contaminants’ population levels. The adopted approach would prove effective in evaluating better management options to reduce negative impacts of wastewater and contaminants for sustainable agro-environment in future

Effect of ketamine infusion in treatment resistant depression and in depressive patients with active suicidal ideations: a study from North India

Background: Treatment resistant depression can be a life-threatening condition as it leads to an increase of suicide attempts by two to three folds. It has been estimated that nearly 1 million people die due to suicide every year, and more than two-third of these cases occur when the person is undergoing a major depressive episode. Ketamine is an NMDA receptor antagonist, an anesthetic agent that is short acting and has recently been used as an antidepressant and anti-suicidal agent. It has been seen that a single intravenous infusion of ketamine at a lower dose. i.e., subanesthetic dose of 0.5 mg/kg over a period of 40 minutes produces antidepressant effect which lasts for about a week and various studies have proved that repeated infusions of ketamine can prolong the duration of the antidepressant response. Methods: It was an observational/descriptive study done in the ketamine clinic/ECT suite of institute of mental health and neurosciences Kashmir (an associate hospital of government medical college Srinagar) which runs once a week. In this study, patients satisfying the criteria of TRD and depressive patients with active suicidal ideations, visiting the ketamine clinic who had given a valid informed consent for ketamine infusion enrolled and observed for ketamine efficacy by using specific scales. The study done over a period of 18 months from January 2020 till July 2021. Results: The response rate of ketamine in our study for treatment resistant depression was 70.27%. The response rate of ketamine for suicidality in our study was 63.16%. Our study showed a rapid onset of action for ketamine, two hours after ketamine infusion. Conclusions: A significant fraction of patients suffering from major depressive disorder do not respond to antidepressants and have a poor psychosocial functioning and an increased risk of suicide attempts making their condition life threatening. These patients therefore require special attention to address their underlying condition as well as suicidality to improve their outcome. In this context we studied the role of intravenous ketamine infusion in these patients in improving the psychosocial outcome as well as preventing the suicidal ideation.

Management aspects of congenital adrenal hyperplasia during adolescence and transition to adult care

The adolescent period is characterised by fundamental hormonal changes, which affect sex steroid production, cortisol metabolism and insulin sensitivity. These physiological changes have a significant impact on patients with congenital adrenal hyperplasia (CAH). An essential treatment aim across the lifespan in patients with CAH is to replace glucocorticoids sufficiently to avoid excess adrenal androgen production but equally to avoid cardiometabolic risks associated with excess glucocorticoid intake. The changes to the hormonal milieu at puberty, combined with poor adherence to medical therapy, often result in unsatisfactory control exacerbating androgen excess and increasing the risk of metabolic complications due to steroid over‐replacement. With the physical and cognitive maturation of the adolescent with CAH, fertility issues and sexual function become a new focus of patient care in the paediatric clinic. This requires close surveillance for gonadal dysfunction, such as irregular periods/hirsutism or genital surgery‐associated symptoms in girls and central hypogonadism or testicular adrenal rest tumours in boys. To ensure good health outcomes across the lifespan, the transition process from paediatric to adult care of patients with CAH must be planned carefully and early from the beginning of adolescence, spanning over many years into young adulthood. Its key aims are to empower the young person through education with full disclosure of their medical history, to ensure appropriate follow‐up with experienced physicians and facilitate access to multispecialist teams addressing the complex needs of patients with CAH