Comparison of open vs Plastibell techniques of circumcision for surgical outcomes and cosmetic satisfaction;A randomized control trial

Objective of the study: To compare the results of circumcision by open technique and the Plastibell technique in male babies. Methods: In this randomized controlled interventional study, 1440 babies whose circumcision was done as religious rite were divided into two groups. Group A underwent circumcision by open technique whereas group B underwent circumcision by Plastibell method. Results: Majority 720 (50%) were in age group 6-8 weeks. Compared with open method, significantly less number of patients in plastibel method experienced moderate pain (47.91% versus 35% p value .00001 and severe pain 31.94% versus 9.02% p value .00001.Rate of wound infection was significantly less in plastibell method 2.77% versus 4.86% p value .020. However more patients in plastibell technique needed re-do circumcision 4.02% versus 1.94% p value .0202. Overall greater parent’s satisfaction was attained with plastibel method. Conclusion: Plastibell technique has many advantages over open method in terms less post op pain, wound infection, and greater cosmetic  satisfaction however more patients will need re-do circumcision in this technique compared with conventional method. Keywords: Circumcision, open technique, Plastibell, post-op complication

US Mass Media and Image of Afghanistan: Portrayal of Afghanistan by Newsweek and Time

The study aims at investigating as how Afghanistan is being represented and portrayed in two leading US magazines - Newsweek and Time. Prefatory pages of the paper shed some light on the growth of economy and media in Afghanistan followed by a brief overview of relations between the US and Afghanistan during the last decade. The contents of twenty leading articles of Newsweek and Time were analyzed which clearly depicts that the proportion of negative coverage (57.08%) was greater than the positive coverage (6.08%). Newsweek and Time mainly represented Afghanistan as an abode of Taliban and extremism, penitentiary for women, a narcotics den, a centre for Islamization, and a safe haven for AlQaida and Usama Bin Laden, to include a few.&nbsp

Gender and Local Governance in Pakistan: Promoting Participation through Capacity Building

Women’s equal and full participation in decision making is extremely important for good governance, poverty alleviation and equitable human resource development in developing countries. Realizing the need, the Devolution of Power Plan system of Pakistan 2001 provided women 33% representation at all, three tiers of local governance including District, Tehsil (Sub District) and Union Council through the adoption of affirmative action/quotas. However, despite this visible formal representation women participation remained low and limited in the previous term of local governance. A review of existing studies on the subject suggests that diverse cultural, political, economic and demographic factors in Pakistan account for women’s low participation in governance. While the situation determines a clear need for capacity building initiatives it is important that a comprehensive gender capacity building framework be developed in view of the indigenous requirements. Based on a systematic analysis of the diverse factors and domains in which this phenomenon takes place, the paper offers useful insights for developing such a framework for local governance of Pakistan. It suggests adopting a two pronged strategy that seeks to promote participation through developing the people (women councilors and groups) and creating enabling environment in institutions. Specific interventions in this regard include provision of requisite knowledge, developing specific skills, building alliances, networking and mentoring at the individual level and gender sensitivity training, advocacy, institutional alliances and linkages, enhancement of the devolution management skills, and research and documentation at the institutional level.&nbsp

Performance Management in Public Sector: A Case of Civil Service in Pakistan

The paper deliberates upon the issue of performance management in the specific context of civil service of Pakistan It evaluates the existing system of Performance Evaluation in view of the New Public Management (NPM) reform initiated during the late 1970s (Daley, 1993) across countries including Pakistan. The study adopts a qualitative approach to draw findings. It reveals that performance management system of the Civil Service of Pakistan at both Federal and Provincial level has certain strengths including; thoroughness, comprehensiveness, disciplined tool for promotion and accountability etc. However, the system also suffers from political meddling, extraneous factors, lack of quantification and standardization that hinder the effective functioning of the system. The paper suggests useful policy recommendations and reform measures towards improving the system in this direction

Research Significance of Clinical Linguistics for Children on Language Speech Therapy in Pakistan: A Paediatric Survey Research

Background: Studying paediatrics’ clinical linguistics can accurately assess the needs and demands of this field and can facilitate impactful and practical advancements in this domain. Objectives: This research aims to identify the research goals of clinical linguistics in Pakistan, as limited studies have been conducted on this subject.Materials and Methods: A comprehensive analysis was conducted on linguistic and speech therapy studies published till 2023 to ascertain the quantity and developmental trajectory of research conducted on clinical linguistics. Findings: The field of linguistics has seen the highest number of research studies undertaken by speech therapists in phonetics/phonology (39%). In comparison, the lowest number of studies have been focused on pragmatics (24%). Linguistics has conducted limited research on diseases, accounting for just 0.4% of the studies. Some of these studies concentrate on aphasia, making up 19% of the research. Consequently, it is necessary to explore other illnesses as well

Clinical Presentations of Multiple Sclerosis at Royal Commission Hospital Yanbu Kingdom of Saudi Arabia

Introduction: Multiple sclerosis (MS) is an important cause of long standing disability especially in adult females. The incidence is more in Europe. In Europe specially in USA and UK the prevalence is about 120/ 100,000. The annual incidence is around 7 per 100,000, while the life time risk of developing MS is about 1in 400. The incidence of MS is higher in northern Europeans, and the disease is about twice as common in females. Objectives: To study various ways the patients of multiple sclerosis presented in the department of neurology atObjectives: To study various ways the patients of multiple sclerosis presented in the department of neurology at Royal commission hospital Yanbu, Kingdom of Saudi Arabia.Materials and Methods: This is new as well newly diagnosed patients who presented in the emergency as well as outpatient department of neurology at Royal Commission hospital Yanbu, Kingdom of Saudi Arabia. Yanbu is one of the biggest industrial city of Saudi Arabia. Duration of study was two years; from January 2011 to December 2012. The study included 50 patients. We diagnosed 45 patients ourselves and 5 patients were following in the neurology OPD.Results: The age range was 17 – 58; 38 patients were females and 2 were males. Most of the affected patients were in the age range of 17 – 36. Mean duration of illness was from 1 – 9 years. In most of the patients, the initial presentation was weakness and visual loss. Most of the patients were started on interferons and they has very good outcome.Conclusions: Multiple sclerosis involves both brain and spinal cord. Early diagnosis and treatment promises good outcome and rehabilitation. The new treatment modalities have played revolutionary role in modulating the disease. Abbreviations: MS = Multiple sclerosis

Revisiting Public Policy Making Process and Strategies in Pakistan: A Governance Perspective

The paper deliberates on the issue of public policy making process and strategies in the specific context of Pakistan in view of the universal call for good governance, efficient service delivery, accountability, participation and sound public policy making through empowering people and leveraging their potential in the process of governance. It emphasizes on the need for revisiting the public policy making process and strategies with a renewed interest at a time when strategy and policy instruments are being intensively debated in the wake of a plethora of economic, social, political and governance problems triggered by the tragic wave of terrorism, militancy and corruption in the country. The paper argues that existing process and strategies of policy making are quite generic, linear and mainstream which provide an overly simplistic and general understanding of the approach in which public policies are formulated. These define policy formulation merely a solution generating process which in turn solves some problems. This procedure consists of sequential steps which begins with identification of a problem, and completes with a set of actions to resolve the problem. Nevertheless, evidence suggests that real world of policy making is much more complex and intricate. Some notable competing approaches in this regard include the “advocacy framework” (Sabatiaer and Jenkins-Smith, 1999), “multiple stream framework” (Kingdons, 1984; Zahariadis, 2003), “rational-choice analysis” (Sharpf, 1997), “policy network approach” (Borzel, 1998; Thatcher, 1998; Howlett, 2002), “policy transfer perspective” (Dolowitz and Marsh, 1996), and “network governance” (Cross, Hesterly, and Borgatti, 1997). While all of the above competing frameworks offer competing explanations they are largely concentrated on pluralist cultures and the way policy choices are made. Therefore, it is challenging to elucidate by what means such frameworks explain policy making where the decision making is done in dictatorial settings i.e. in those countries which are politically independent but economically dependent on international financial institutions, who have elected governments but without people centric democracy, who gained independence from colonial rule but are still well-entrenched in colonial traditions, and whose intellectuals are highly educated and well- read but have captive mindset. To address the issue the paper suggests utilizing a network governance perspective with decentralized/bottom up approach for effective policy making in Pakistan and recommends ways towards effective public policy based on a realistic, context specific, collaborative and participative approach.&nbsp

Impact of Environmental Factors on the Working of Photovoltaic Cells

This paper discussed the stimulation of diffused and global sun rays on the site of Pakistan, striking the PV cell, is done for varying environmental conditions. This is done with the help of model used for spectral transmittance. Different effects are examined including efficiency of various types of PV cells, variation in whole intensity and the distribution of spectrum on short circuit current. The outcome shows an inverse relationship between turbidity and short circuit current. In the case of global sun rays the reduction of short circuit current due to turbidity is 4.4% for monocrystalline PV cell, 4.8% for multicrystalline PV cell and 7.33% for amorphous PV cell but in case of diffuse sun rays it increases. The relationship between short circuit current and water vapors is also inverse but this effect shows only in case of global sun rays. The decrement in the short circuit current due to water vapor is 4.6% for moncrystalline, 4.39% for multicrystalline, and 0.19% in case of amorphous. The increment in the air mass causes decrement in the short circuit current for various kinds of PV cells. But in case of monocrystalline and multicrystalline there is an increment in efficiency due to air mass effect while the efficiency of amorphous decreases

Utilisation of an operative difficulty grading scale for laparoscopic cholecystectomy

Background A reliable system for grading operative difficulty of laparoscopic cholecystectomy would standardise description of findings and reporting of outcomes. The aim of this study was to validate a difficulty grading system (Nassar scale), testing its applicability and consistency in two large prospective datasets. Methods Patient and disease-related variables and 30-day outcomes were identified in two prospective cholecystectomy databases: the multi-centre prospective cohort of 8820 patients from the recent CholeS Study and the single-surgeon series containing 4089 patients. Operative data and patient outcomes were correlated with Nassar operative difficultly scale, using Kendall’s tau for dichotomous variables, or Jonckheere–Terpstra tests for continuous variables. A ROC curve analysis was performed, to quantify the predictive accuracy of the scale for each outcome, with continuous outcomes dichotomised, prior to analysis. Results A higher operative difficulty grade was consistently associated with worse outcomes for the patients in both the reference and CholeS cohorts. The median length of stay increased from 0 to 4 days, and the 30-day complication rate from 7.6 to 24.4% as the difficulty grade increased from 1 to 4/5 (both p < 0.001). In the CholeS cohort, a higher difficulty grade was found to be most strongly associated with conversion to open and 30-day mortality (AUROC = 0.903, 0.822, respectively). On multivariable analysis, the Nassar operative difficultly scale was found to be a significant independent predictor of operative duration, conversion to open surgery, 30-day complications and 30-day reintervention (all p < 0.001). Conclusion We have shown that an operative difficulty scale can standardise the description of operative findings by multiple grades of surgeons to facilitate audit, training assessment and research. It provides a tool for reporting operative findings, disease severity and technical difficulty and can be utilised in future research to reliably compare outcomes according to case mix and intra-operative difficulty