How Do the Poor Respond to Rising Prices?

Recent estimates show that after falling in the 1980s, poverty has made a comeback in Pakistan during the 1990s. The Government of Pakistan (GOP) estimate show an increase in caloric poverty headcount from 17 percent in 1987-88 to 33 percent in 1998-99 and also rising income inequality during the 1990s.1 In contrast preliminary estimates by the World Bank show that poverty may not have risen as rapidly during the 1990s and may even have stagnated.2 Slow down in economic growth, rising open unemployment, rising food and non-food prices, reduction in the fiscal space for pro-poor public programmes, poor governance hampering delivery of social services to the poor; are factors that have been attributed to the growing poverty and vulnerability of households in recent years. The Government has recently taken some important initiatives to deal with rising poverty. These include the Rs 21 billion Integrated Rural Urban Development public works programme, establishment of the Khushali Bank (Micro-Finance Bank) and the Food Support Programme for poor households with income less than Rs 2000/ PM. These programmes are in addition to the existing public social safety net programmes such as Zakat/Ushr and Pakistan Baitul Maal, and the Social Action Programme. The ongoing work on the Poverty Reduction Strategy Paper (PRSP) is a laudable effort by the government to take poverty issues seriously and to come up with a poverty reduction strategy in a consultative and participatory manner.

Finding Factors Causing Postdural Puncture Headache In Obstetric Patients After Spinal Anaesthesia

Objective: Among various recognized factor of spinal headache the single most important causative factor is size of spinal needle. The aim of this study was to determine incidence of spinal headache with 27 GQuincke Babcock spinal needle in Caesarean section patients. Materials and Methods: This observationalcross sectional study was carried out in the Combined Military Hospital Gujranwala and Pakistan Naval Shipping Rahat Hospital Karachi from Jan 2011 to Jan 2013. In 500 Caesarean section (C section) cases preloaded with 1000 ml Ringers Lactate, 27 G QuinckeBabcok spinal needle was used in sitting as well as left lateral position for spinal anaesthesia in all patients using local anaesthesia plain lidocaine 2% 1-2ml.In interspace L 2-3 / L3-4 eitherBupivacaine hydrochloride hyperbaric 0.75 % or 0. 5% was injected. All Caesarean cases were included except contraindicated. Spinal needle Quincke Babcock 27 G alone was used.The results were presented in percentages, mean and standard deviation. Results: A total of 500 patients of c-section were evaluated. Overall incidence of true spinal headache was 2%, failed spinal anaesthesia 4%, spinal needle was changed in 3 %, success rate of 96 % and maternal acceptance 47.4 %. Single pricks were 59.4 % while 2-3 pricks were 40.6 % . Conclusion: Smaller spinal needle has changed the safety profile of spinal anaesthesia in C section cases by very low failure rates and true PDPH a rarity. PDPH will continue as long as dura is punctured but incidence can be decreased by different technique

Distribution of Common Coot (Fulica atra) Collected from Wet Lands of Punjab, Pakistan

Population survey was conducted to evaluate the population of common coot (Fulicaatra) and ten years population trend at Chashma Barrage (29883±6458), Taunsa Barrage (4198±515), Ucchali Lake (7253±1466), Head Qadirabad (2789±785), Head Marala (3226±984), Head Rasool (3261±84)), Khabbeki Lack (1486±230), Head Sulaimanki (1809±180), Jhalar Lake (526±206) and Head Islam (1779±257). The population atChashma barrage was statistically highly significant as compared to other wetlands. The overall year wise abundance and relative abundance of different wet lands were recorded. To evaluate the food preference, total weight of gut (63.98±3.946), total weight of gizzard (26.99 ± 1.325), weight of food material (3.59±0.187), gizzard weight without food material (23.39± 1.244), weight of seed (1.24± 0.075), weight of vegetation (1.65±0.103) and weight of other material (0.69±0.067) were calculated. The comparison between male and femalegave results that the total weight of gut, total weight of gizzard, weight of food material, Gizzard weight without food material and weight of other material was statistically highly significant and weight of seed, weight of vegetation was statistically significant.The richness, abundance, Shannon’s variety list, Simpson’s variety record and evenness for gizzard contents were calculated. Among the 40 samples, 19 samples were found infected in by parasites of seven types of Gastro-intestinal parasites were distinguished and recorded as Amidostomum anseris, Capillaria contorta, Strongyloides avium, Echinoparyphium recurvatum, Notocotylus attenuatus, and Giardia sp. D. balacea was recorded among the six wetlands. S. avium and N. attenuates wererecorded among the four wetlands, A. anseris, E. recurvatum and Giardia sp. wererecorded among the three wetlands, and C.contortawererecorded among the two wetlands.The current study provides the information for the management planning, conservation and improvement of habitat of common coot. The knowledge of parasites can be helpful to grasp the host-parasite interactions and give important standard data to the assessment of fitness and wellbeing status of this species

Incidental metastatic mediastinal atypical carcinoid in a patient with parathyroid adenoma: a case report.

Background: Atypical carcinoid arising from the mediastinal tissue is a rare neuroendocrine tumor and an association with parathyroid adenoma is very unusual. We report an unusual case of atypical carcinoid of mediastinum with metastasis in a patient presenting with parathyroid adenoma, which is the first case to be reported from Pakistan. Case presentation: A 51-year-old Pakistani man was seen in postoperative intensive care after right parathyroidectomy and mediastinal mass resection for the management of postoperative hypocalcaemia. He had a background history of dyspnea. Examination was unremarkable. Preoperative laboratory evaluation revealed a calcium level of 12.7 mg/dl, phosphate of 1.9 mg/dl, serum albumin of 4.8 g/dl, alkaline phosphate of 94 U/L, and serum intact parathyroid hormone level 413.8 pg/ml. A technetium-99m sestamibi parathyroid scan showed right parathyroid increased tracer uptake. Further workup revealed a large mediastinal mass which was diagnosed as atypical carcinoid after Tru-Cut biopsy. He underwent right-sided parathyroidectomy and resection of the mediastinal mass. The histopathology confirmed it to be a parathyroid adenoma and atypical carcinoid tumor of his mediastinum with metastasis in his lymph node and parathyroid gland. Somatostatin receptor scintigraphy revealed a well-defined focus in his left hypochondriac region consistent with a somatostatin receptor scintigraphy-avid tumor. He was started on everolimus and planned for octreotide therapy. Conclusions: We describe an incidental finding of atypical carcinoid of the mediastinum in a patient diagnosed as having parathyroid adenoma. Clinical manifestations of neuroendocrine syndromes are challenging. Some tumors cluster in a non-classic description with other common neoplasms. They rarely present in isolation, remain clinically silent, and need aggressive workup with the aid of imaging and histopathology

Peri-operative determinants of prolonged CICU stay after coronary artery bypass graft surgery in elderly at a private tertiary care hospital: a case control study

Abstract OBJECTIVE: To explore peri-operative risk factors associated with prolonged stay in cardiac intensive care unit among patients undergoing isolated coronary artery bypass grafting. METHODS: This retrospective case control study was conducted at the Aga Khan University Hospital, Karachi, comprised medical records of patients who had undergone cardiothoracic revascularisation surgery from January 2006 to December 2013. The patients were grouped into cases and controls at a ratio of 1:2 on the basis of length of stay at cardiac intensive care unit, i.e. \u3e72 hours andanalysis. RESULTS: Of the 999 patients, 333(33.3%) were cases and 666(66.6%) were controls. The mean age of cases was 62.5±9.7 years and that of controls was 60.8±9.6 years (p=0.007). The number of males was 280(84.1%) among the cases and 489(73.4%)among the controls. Adjusted odds ratio and 95% confidence interval for age and male gender were 1.02 (1.0,1.03) and [1.90 (1.32,2.74)]; diabetics were at high risk of staying longer [1.51 (1.13,2.02)]; previous cardiovascular interventions [1.65 (1.05,2.59)], intra-aortic balloon pump insertion [1.45 (1.01,2.08)], initial ventilation time and post-operative bleeding tamponade were independently associated with prolonged cardiac intensive care unit stay [1.01 (1.00, 1.01)] and [1.9 (1.13,3.2)], respectively. The risk of dying among the cases was three times more after adjusting for all covariates in the model [3.1 (1.52,6.31)]. CONCLUSION: Advanced age, male gender, diabetes, previous cardiovascular interventions, post-operative intra-aortic balloon pump insertion, initial ventilation support and post-op bleeding tamponade were found to be the independent risk factors for prolonged cardiac intensive care unit stay

Mutations in the E2-PePHD region of hepatitis C virus genotype-3a and correlation with response to interferon and ribavirin combination therapy in Pakistani patients

Hepatitis C is a major health problem affecting more than 200 million individuals in the world. Current treatment regimen consisting of interferon alpha and ribavirin does not always succeed in eliminating the virus completely from patient's body. One of the mechanisms by which virus evades the antiviral effect of interferon alpha involves protein kinase (PKR) eukaryotic initiation factor 2 alpha (eIF2a) phosphorylation homology domain (PePHD). This domain in genotype 1 strains is reportedly homologous to PKR and its target eIF2a. By binding to PKR, PePHD inhibits its activity and therefore cause virus to evade antiviral activity of interferon (IFN). Many studies have correlated substitutions in this domain to the treatment response and lead to inconclusive results. Some studies suggested that substitutions favor response while others emphasized that no correlation exists. In the present study we therefore compared sequences of PePHD domain of thirty one variants of six hepatitis C virus patients of genotype 3. Three of our HCV 3a infected patients showed rapid virological response to interferon alpha and ribavirin combination therapy whereas the remaining three had breakthrough to the same combination therapy. It is found that PePHD domain is not entirely conserved and has substitutions in some isolates irrespective of the treatment response. However substitution of glutamine (Q) with Leucine (L) in one of the breakthrough responders made it more identical to HCV genotype 1a. These substitutions in the breakthrough responders also tended to increase average hydrophilic activity thus making binding of PePHD to PKR and inhibition of PKR more favorable

Introduction and evolution of dengue virus type 2 in Pakistan: a phylogeographic analysis

Discrete Bayes Factors from SPREAD. Locations are denoted with two letter codes (Additional file 5: Table S3). The upper half of the matrix shows the mean (standard deviation) for the discrete Bayes Factor calculated for the 12 discrete trait models. The lower half of the matrix shows how many times a linkage had a Bayes Factor greater than 3.0. (XLSX 9 kb

Numerical simulation of lead-free vacancy ordered Cs 2 PtI 6 based perovskite solar cell using SCAPS-1D

In recent years, vacancy-ordered halide double perovskites have emerged as promising non-toxic and stable alternatives for their lead-based counterparts in optoelectronic applications. In particular, vacancy ordered Cs2PtI6 has emerged as a star material because of its high absorption coefficient, band gap of 1.37 eV, and long minority carrier lifetime. Despite substantial experimental research on this new class of material, theoretical simulations of their device properties remain scarce. In this work, a novel n-i-p device architecture (FTO/SnO2/Cs2PtI6/MoO3/C) is theoretically investigated using a solar cell capacitance simulator (SCAPS-1D). Theoretical investigations are carried out in order to optimize the device performance structure by varying the perovskite and selective charge transport layer thickness, absorber and interface defect density, operating temperature, back contact, series and shunt resistance, respectively. The optimized device showed an impressive power conversion efficiency (PCE) of 23.52% at 300 K, which is higher than the previously reported values. Subsequent analysis of the device's spectral response indicated that it possessed 98.9% quantum efficiency (QE) and was visibly active. These findings will provide theoretical guidelines for enhancing the performance of Cs2PtI6-based photovoltaic solar cells (PSCs) and pave the way for the widespread implementation of environmentally benign and stable perovskites