Cost of Justice and Exclusion

The main objective of an economic system is to help people in satisfying the basic necessities of life without compromising an individual’s freedom. However, almost every society in the world depicts a clear division among people. Some individuals have access to all facilities required for a decent life, while others are excluded from having such facilities. This paper focuses on testing whether this is the case with the judicial system of Pakistan. Based on the philosophical approach towards life, this paper assumes that the foundation on which the current judicial system has been evolved is exclusive in its nature. The paper attempts to show that the exclusive nature of the judiciary cannot become inclusive until we bring the philosophy of the current economic system in line with reality. The paper claims that the philosophy of the current economic system protects the interest of rich and wealthy people. Hence, all sub-systems such as political, judicial, and executive mainly facilitate and promote the welfare of rich people. The final outcome is in favor of those who are wealthy and have high intercept in the society in terms of money and social capital (links with influential people such as politicians/bureaucrats/army generals, etc.). On the other hand, the intuitional framework of the judiciary is less likely to help those who fall into the group of people who do not have money and social capital. The paper test the presumptions empirically based on the primary data collected from Lawyers in the district courts of Islamabad. Here we compare the cost of various types of cases across courts with the average income of an average family. The average cost of almost all types of cases is higher than the average income of an average family. This shows the excludability of the judicial structure of Pakistan. The average family income is calculated from Household Integrated Economics Survey (HIES). The study suggests that a judicial structure with the agents having primary objective of settling the disputes of people are required. The current structure has flaw as it link earnings with the disputes of people. We need a society where the ills of one such as diseases, disputes, weakness, etc., should not become the source of earning for others. The study also claims that until we develop such a society, the true spirit of justice will remain a mere dream for the excluded people

Catatonia in The General Hospital: A Case Series Wading Through Diagnostic & Management Challenges

ABSTRACT Catatonia is a cluster of affective, behavioral, and motor symptoms. Its causes are multifactorial ranging from severe and untreated psychiatric illnesses to neurological diseases and other general medical conditions. It is estimated that 20% of catatonia causes are due to medical conditions out of which two thirds are due to an underlying neurological condition which might include encephalitis, neural injury, developmental disorders, structural brain pathology, or seizures. Symptoms of catatonia can wax and wane, fluctuating between the retarded and the excited type within hours making it more difficult to identify and diagnose. If left untreated, catatonia can lead to multiple medical complications which can lead to significant long-term morbidity and mortality. The initial complications include dehydration, malnourishment, electrolyte imbalance, deep venous thrombosis, pulmonary embolism, pneumonia, urinary tract infection, and retention. In the long run, patients can have sepsis, rhabdomyolysis, DIC, decubitus ulcers, arrhythmia, renal failure, and liver dysfunction. This article will describe three patients (adolescent & adult) that presented to Aga Khan University Hospital (AKUH), Karachi with challenging presentations of catatonia. Their diagnostic and management difficulties will be discussed

2-[(E)-3-Phenyl­prop-2-en­yl]-1,2-benzisothia­zol-3(2H)-one 1,1-dioxide

In the crystal structure of the title compound, C16H13NO3S, the benzisothia­zole group is almost planar (r.m.s. deviation for all non-H atoms excluding the two O atoms bonded to S = 0.009 Å). The dihedral angle between the fused ring and the terminal ring is 13.8 (1)°. In the crystal, mol­ecules are linked through inter­molecular C—H⋯O contacts forming a chain of mol­ecules along b

Hybrid Technique for Estimating Fetal Head Circumference Using Ultrasound Imaging

Introduction: Analysis of fetal head shape is crucial for assessing head growth and detecting abnormalities in fetuses. In traditional clinical practice, Head Circumference (HC) is determined by manually fitting an ellipse to the fetal skull based on 2D ultrasound images. Novelty Statement: To address this, an automated method integrating image processing techniques with U-net variant have been developed to achieve maximum accuracy of fetal head circumference detection on HC18 dataset. This method aims to enhance precision in HC delineation, thereby improving clinical reliability. Material and Method: This study proposed a method that combines image processing techniques (noise removal, edge detection, segmentation) with a Residual U-net model for detecting the boundary of the fetal skull using HC18 dataset. Results and Discussion: The results of this method outperformed a simple residual u-net model in terms of accuracy. The proposed method is evaluating using the HC18 challenge dataset, achieving a Dice coefficient of 97.99%, a mean difference of 5.86 mm, and a mean Hausdorff distance of 0.56 mm compared to manual annotations. These results demonstrate the effectiveness of the proposed method in accurately delineating the fetal skull boundary. Concluding remarks: Furthermore, the proposed method shows comparability with state-of-the-art techniques in the field

Hybrid Technique for Estimating Fetal Head Circumference Using Ultrasound Imaging

Introduction: Analysis of fetal head shape is crucial for assessing head growth and detecting abnormalities in fetuses. In traditional clinical practice, Head Circumference (HC) is determined by manually fitting an ellipse to the fetal skull based on 2D ultrasound images. Novelty Statement: To address this, an automated method integrating image processing techniques with U-net variant have been developed to achieve maximum accuracy of fetal head circumference detection on HC18 dataset. This method aims to enhance precision in HC delineation, thereby improving clinical reliability. Material and Method: This study proposed a method that combines image processing techniques (noise removal, edge detection, segmentation) with a Residual U-net model for detecting the boundary of the fetal skull using HC18 dataset. Results and Discussion: The results of this method outperformed a simple residual u-net model in terms of accuracy. The proposed method is evaluating using the HC18 challenge dataset, achieving a Dice coefficient of 97.99%, a mean difference of 5.86 mm, and a mean Hausdorff distance of 0.56 mm compared to manual annotations. These results demonstrate the effectiveness of the proposed method in accurately delineating the fetal skull boundary. Concluding remarks: Furthermore, the proposed method shows comparability with state-of-the-art techniques in the field

Radiology: A new hope to help differentiate between types of dementia

Lewy body dementia (LBD) is one of the disabling conditions commonly seen in elderly population, characterized by parkinsonian-like features, visual hallucinations, fluctuating levels of cognition, and Rapid Eye Movement (REM) sleep behaviour disorder. As per recent statistics, low-middle income countries account for 58% of the world's population aging with dementia. By 2050, the population aging with dementia is expected to rise to 68%. Worldwide, developing countries bear 60% of the burden of patients with dementia. Approximately, Pakistan has 150,000–200,000 dementia patients.(1) True prevalence of LBD remains unknown owing to less diagnosed cases, however one meta-analysis has quoted the prevalence of around 7.5% in clinical population.(2)  Another study has quoted around 4.2%.(3) The variation in the studied prevalence could be explained by the face that despite presence of clinical biomarkers,(4) and a validated diagnostic tool,(5) DLB remains undiagnosed in majority of the cases. For several years, it was hypothesized that combining single-photon emission computed tomography with an intravenous radioactive compound, [123I] FP-CIT, could assist in differentiating Lewy body dementia from Alzheimer’s disease (AD) dementia. Several dopamine-producing neurons are found in abundance in striatum and [123I] FP-CIT binds to dopamine transporters located on their membrane. Since these neurons are reduced in quantity in dementia with Lewy bodies (just as they are in Parkinson’s disease), but not in Alzheimer’s disease, this pattern of distribution would then aid in quantitatively distinguishing DLB from AD in an accurate way. Neuroimaging techniques such as FP-CIT-SPECT and [123I] MIBG can be useful in adding diagnostic accuracy. However these techniques are not very accurate in diagnosing dementias on spectrum(6)  LBD poses unique challenges due to being complex multi-symptom disorder that affects quality of life and increased caregiver burden. The difficulties arise not only due to this disabling disease but lack of knowledge, awareness and subsequently proper management(7)  When diagnosis is made in due time, it enables planning for the future and improves quality of care. In the context of such limitations to treatment, we propose that the use of such investigations and more research to be done in this area as that could help bridge the gap between our currently available diagnostic options and the increasing burden of dementia in Pakistan

Endoxifen: A new hope for bipolar disorder

Bipolar Disorder (BD), originally called manic depressive illness, is one of the most challenging and disabling psychiatric disorders to manage with an estimated life time prevalence of 1.02%. (1) One of the challenges is limitations in our understanding of the pathophysiology of the disorder which ultimately will lead to better treatment options. Despite available treatment options, literature reports breakthrough episodes in treated groups ranging from 40% to 60%. (2) This makes it even more crucial to gain more insight into the pathophysiology. Advances in molecular neuropsychiatry have reported that bipolar disorder is associated with overactive protein C kinase intracellular signaling. (3) Reportedly, lithium and valproate are protein C kinase inhibitors. Research has shown promise in effectiveness of Endoxifen. A multicenter, double-blind, active-controlled study was conducted using Endoxifen compared with Divalproex, the current standard treatment, in patients with BD. This new protein kinase C inhibitor has shown effectiveness in the treatment of acute mania and mixed mania. (4) One of the many advantages include similar efficacy as Divalproax without inducing thrombocytopenia and reportedly no need for drug monitoring due to wide therapeutic index is one of the reasons which results in decreased compliance. Additionally, it crosses the blood-brain barrier independent of CYP-2D6 metabolism. (4) With regards to disadvantages, cost effectiveness is a major hurdle. These new insights into pathophysiology and treatment options are crucial as till date BD remains one the most disabling mental health disorder affecting every aspect of life; individual, social, economic, global. BD is the fifth leading cause among psychiatric disorders of lost years of work. (5) It is therefore imperative that a new treatment is established and further research is warranted in regards to Endoxifen for better understanding to develop safe treatment, not only for management but possible cure. Continuous..