The Role of IS in Islamic Banking: A Cultural Perspective

This research is located in the topic area of culture and information systems. It is set in the finance industry against the backdrop of globalisation. The particular focus is on the influence of Islamic culture on the role and development of information systems in Islamic banking. The notion of role is treated as a rich description of the behaviour and responsibilities of information systems. This research will use ANT (Actor Network Theory) to study the relevant actors i.e. humans and non-humans, heterogeneous networks and relationships that form the research area. An interpretive approach has been adopted for this work, using multiple case studies. The underlying theories and research design are discussed for this research in progress

Management of Intracranial Hydatid Cyst

Objective: To know the clinical presentation and surgical complication of intracranial hydatid cyst.Materials and Methods: This retrospective study was done in neurosurgery department of Hayatabad Medical Complex, Peshawar, from 2nd February 1998 to 1st October 2012. A total of 37 patients with intracranial hydatid cyst, irrespective of gender discrimination were included in this study. Intracranial hydatid cyst was diagnosed on CT scan brain. The information regarding patient demographical details, clinical features, CT brain findings and post-operative complications was documented in patient’s Performa. The data was analyzed by SPSS version 16. Frequency and percentage was calculated for categorical variables. Mean ± SD was calculated for age. Results were presented as tables.Results: A total of 37 patients were included in the study. Out of 37 patients, there were 23 (62.8%) males and 14 (37.14%) females. The mean age was 12.4 years. Most of patients presented with increased intracranial pressure features like headache, vomiting and papilloedema. Majority of the patients had hydatid cyst in parietal region %. Post-operatively two patients having wound infection and no mortality.Conclusion: Hydatid disease should be kept in the differential diagnosis of cystic lesion of the brain. The pericystic hydraulic hydatid cyst excision is the safe procedure with minimal morbidity

Chronic Subdural Hematoma in Elderly Patients after Trivial Head Injury

Background: Chronic subdural hematoma is a benign disease but its behavior is more than a malignant space occupying lesion intra-cranially and it kills patient, if diagnosis delayed. Chronic subdural hematoma is frequently associated with underlying co-morbidities like diabetes mellitus, hypertension, ischemic heart diseases and atrial fibrillation in elderly patient. Early recognition of chronic subdural hematoma is important for early management.Objective: To identify the factors for causing chronic sub-dural haematoma following minor head injury.Materials and Methods: This observational descriptive study was conducted in the Department of Neurosurgery “A” Unit, Lady Reading Hospital Peshawar from 1st January 2016 to 31st July 2018. All patients with history of minor head injury resulting in unilateral or bilateral chronic subdural hematoma diagnosed clinically and radiologically by CT scan/MRI brain, Age greater than 60 years & operated for chronic subdural hematoma were included in this study. Exclusion criteria was all chronic subdural hematoma patients with age less than 60 years and previous operated. Medical records of patients were revised and searched for associated risk factors. A proforma was designed for collection of data. The data was analyzed through SPSS Version17.Results: Total number of patients were (46) with male to female ratio (3:1). Clinical presentations were decreased level of consciousness in 11 patients (23.9%), Headache in 10 patients (21.7%), Memory loss in 5 (10.8%), Personality changes in 10 patients (21.7%), Motor deficits in 5 patients (10.8%), Aphasia in 5 patients (10.8). The risk factors found were Diabetes Mellitus 8 cases (17%), Hypertension 16 cases (35%), Rheumatic heart disease 1 case (3%), Ischemic heart disease 15 cases (32%) and atrial fibrillation 6 cases (13%).Conclusion: The common risk factors for chronic subdural hematoma was ischemic heart disease, hypertension, diabetes mellitus and atrial fibrillation. Early management results in favorable prognosis in terms of morbidity and mortality

Outcome of Traumatic Posterior Fossa Epidural Hematomas

Objective: To present our experience in the management and outcome of posterior fossa epidural hematoma (PFEDH).Materials and Methods: It was a descriptive study, conducted in Head injury unit Hayatabad Medical Complex, Peshawar, from December 2009 to October 2012. All patients having traumatic posterior fossa extradural hematoma confirmed on CT Brain were included in this study. The information regarding patient demographical details, clinical presentation, operative finding and post operative follow-up findings were entered into a semi structure Performa. The data was analyzed by SPSS version 17.Results: Out of 41 patients, there were 32 (75.6%) males and 9 (21.9%) females. The age of patients ranged from 5 to 60 years. In this study the mean age was 20.4 years. Majority of patients 17 (41.4%) were in the age range of 21 – 30 years. Pre-operative GCS score were recorded in which most of the patients 21 (51.2%) were in the GCS score 13 – 15. Clinically 33 patients presented with vomiting, 25 with altered level of consciousness, and 29 with headache. Post-operative GCS score were recorded in which 31(75.6%) patients were in the GCS score 13 – 15, 9 (21.9%) patients were in the GCS score 9 – 12 and 1 (2.43%) patient was in the GCS score 3 – 8. Conclusion: CT scan brain should be immediately done if there is even little doubt of posterior fossa extra-dural haematoma (PFEDH). Posterior fossa creniectomy has got good results. Mortality and morbidity can be decreased in PFEDHs if they are diagnosed earlier and promptly treated

Transnasal Trasnssphenoidal Surgery for Pituitary Tumours

Objective: To determine the frequency of early post-operatively complications of transnasal transsphenoidal surgery for pituitary adenoma.Study design: Descriptive study.Place and Duration of Study: Pak International Medical Science Khyber Pakhtoonkhawa from 1st February 2008 to 31st July 2011.Material and methods: A total 41 patients with pituitary adenoma fulfilling the inclusion and exclusion criteria were included in this study. All patients were undergone transnasal transsphenoidal surgery. These patients were followed up for early complications of transsphenoidal surgery for one month.Results: Out of 41 patients, there were 23 (56.09%) males and 18 (43.9%) females. The age of patients ranged from 10 to 70 years. In this study the overall mean age was 44.75 years. Majority of patients fourteen (34.14%) were in the age range of 41 – 50 years, followed by eleven (26.8%) patients in age group of 31 – 40 years, seven (17.07%) patients were in the age range of 51 – 60 years, five (12.1%) in the age range of 61 – 70 years, three (7.31%) in the age group of 21 – 30 years and one (2.4%) in the age group of 10 – 20 years. Early post-operative complications were diabetes insipidus in four (7.31%) patients, CSF leak two (4.87%) patients, meningitis in one (2.43%) patient and epistaxis in one (2.43%) patient.Conclusions: Surgical complications of Transnasal transsphenoidal surgery are minimal. Transnasal trans-sphenoidal surgery is a safe and effective treatment for pituitary tumour

Frequency of Extra-dural Hematoma in Patients with Head Injury

Objectives: To determine the frequency of extra-dural hematoma in patients with head injury.Patients and Methods: This cross sectional descriptive study was done in neurosurgery department of Hayat-abad Medical Complex, Peshawar, from 2nd February 2012 to 1st September 2012. All patients of head injury, from all ages and both genders were included. Patients in whom EDH caused by bleeding disorders or vascular malformations of the dura mater and post surgical EDHs were excluded from the study. CT scan brain was done for all patients to confirm their diagnosis. The information regarding patient demographical details, clinical presentation and site and size of hematoma was documented in patient’s Performa. The data was analyzed by SPSS version 17.Results: A total of 281 patients with head injuries were included in the study. Out of 281 patients, there were 191 (67.9%) males and 90 (32.02%) females. The mean age was 27 years. Majority of patients 81 (28.8%) were in the age range of 21 – 30 years. EDH was found in 31 (11.03%) patients. Eleven patients (3.91%) had their hemato-mas in temporal region. Temporo-parietal region was involved in 9 (3.2%) patients. Frontal and parietal region was affected in 5 patients (1.78%) each. One patient had extra-dural hematoma in posterior cranial fossa.Conclusion: Extra-dural haematoma is fond in 11% of head injury cases. It is more contain in males as com-pared to females. It is most common in 20 – 40 years of age, temporal and parallel cases are most frequently in-volved regions. The mortality in head injury patients can be reduced if extra-dural hematoma diagnosis and operation done early

Outcome of Endoscopic Third Ventriculostomy (ETV)

Objective: To know the surgical outcome of endoscopic third ventriculostomy (ETV) in non communicating hydrocephalous.Materials and Methods: This cross sectional descriptive study was done in the department of neurosurgery PGMI / Hayatabad Medical Complex, Peshawar, from 2nd February 2011 to 1st march 2012. A total of 35 patients with non-communicating hydrocephalous, irrespective of gender discrimination were included in this study. Patients below two years of age and hydrocephalus with infected CSF or hemorrhage were excluded. Hydro-cephalous was diagnosed on CT scan brain. The information regarding patient demographical details, causes of hydrocephalus and complications of procedure were documented in patient’s Performa. The data was analyzed by SPSS version 17. Frequency and percentage was calculated for categorical variables. Mean ± SD was calcu-lated for age. Results were presented as tables.Results: A total of 35 patients with non-communicating hydrocephalous were included in the study. Out of 35 patients, there were 22 (62.8%) males and 13 (37.21%) females. The mean age was 21 years. Etiologically tuber-culous meningitis was the commonest cause of non communicating hydrocephalous. Post-operatively CSF leak-age was present in 3 (8.6%) patients, pseudomeningocele in 2 (5.7%) patients, transient memory loss in 1 (2.8%) and pneumo-cephalous in 1 (2.8%).Conclusion: The complications of endoscopic third ventriculostomy are transient. Those patients who meet the criteria, endoscopic third ventriculostomy offers the possibility of freedom from shunt dependency

Management of Cervical Neurofibroma Type

Objective: To determine the clinical presentation and postoperative outcome of cervical neurofibroma type 1.Study design: Retrospective study.Place and Duration of Study: Hayatabad Medical Complex Hospital Peshawar Khyber pakhtoonkhawa from 1st February 1999 to 31st July 2011.Material and Methods: A total 41 patients with symptomatic cervical spine neurofibromas who underwent surgical decompression and tumor resection were included in this study. Both gender (male and female) and patients in the age range of 20 – 70 years were included in this study. These patients were operated through posterior approach of the cervical spine and then followed for six months for postoperative outcome .The patients’ demographic details and clinical manifestation were entered into a semi structured proforma. Data was analyzed through statistical program SPSS version 11.Results: Out of 41 patients, there were 22 (53.6%) males and 19 (46.3%) females. The age of patients ranged from 20 to 70 years. In this study the overall mean age was 39.2 years. Majority of patients 19 (46.3%) were in the age range of 31 – 40 years. Most common clinical presentation of patient were quadrapresis in 23 (56.1%) pain neck 9 (22%) paraparesis 9 (22%) patients. Postoperatively most of the patients recovered from their preoperative symptoms.Conclusions: Quadraparesis and pain neck were the common clinical presentation of cervical cord neurofibroma type 1. Surgical outcome of cevical neurofibroma type 1 is good

Supervised treatment in outpatients for schizophrenia plus (STOPS+): protocol for a cluster randomised trial of a community-based intervention to improve treatment adherence and reduce the treatment gap for schizophrenia in Pakistan

Introduction There is a significant treatment gap, with only a few community-based services for people with schizophrenia in low-income and middle-income countries. Poor treatment adherence in schizophrenia is associated with poorer health outcomes, suicide attempts and death. We previously reported the effectiveness of supervised treatment in outpatients for schizophrenia (STOPS) for improving treatment adherence in patients with schizophrenia. However, STOPS was evaluated in a tertiary care setting with no primary care involvement, limiting its generalisability to the wider at-risk population. We aim to evaluate the effectiveness of STOPS+ in scaling up the primary care treatment of schizophrenia to a real-world setting. Methods and analysis The effectiveness of the STOPS+ intervention in improving the level of functioning and medication adherence in patients with schizophrenia in Pakistan will be evaluated using a cluster randomised controlled trial design. We aim to recruit 526 participants from 24 primary healthcare centres randomly allocated in 1:1 ratio to STOPS+ intervention and enhanced treatment as usual arms. Participants will be followed-up for 12 months postrecruitment. The sample size is estimated for two outcomes (1) the primary clinical outcome is level of functioning, measured using the Global Assessment of Functioning scale and (2) the primary process outcome is adherence to treatment regimen measured using a validated measure. An intention-to-treat approach will be used for the primary analysis. Ethics and dissemination Ethical approval has been obtained from Keele University Ethical Review Panel (ref: MH-190017) and Khyber Medical University Ethical Review Board (ref: DIR-KMU-EB/ST/000648). The results of the STOPS+ trial will be reported in peer-reviewed journals and academic conferences and disseminated to local stakeholders and policymakers

Early Intervention in Psychosis and Management of First Episode Psychosis in Low- and Lower-Middle-Income Countries: A Systematic Review

Background and Hypothesis People with first-episode psychosis (FEP) in low- and lower-middle-income countries (LMIC) experience delays in receiving treatment, resulting in poorer outcomes and higher mortality. There is robust evidence for effective and cost-effective early intervention in psychosis (EIP) services for FEP, but the evidence for EIP in LMIC has not been reviewed. We aim to review the evidence on early intervention for the management of FEP in LMIC. Study Design We searched 4 electronic databases (Medline, Embase, PsycINFO, and CINAHL) to identify studies describing EIP services and interventions to treat FEP in LMIC published from 1980 onward. The bibliography of relevant articles was hand-searched. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. Study Results The search strategy produced 5074 records; we included 18 studies with 2294 participants from 6 LMIC countries. Thirteen studies (1553 participants) described different approaches for EIP. Pharmacological intervention studies (n = 4; 433 participants) found a high prevalence of metabolic syndrome among FEP receiving antipsychotics (P ≤ .005). One study found a better quality of life in patients using injectables compared to oral antipsychotics (P = .023). Among the non-pharmacological interventions (n = 3; 308 participants), SMS reminders improved treatment engagement (OR = 1.80, CI = 1.02–3.19). The methodological quality of studies evidence was relatively low. Conclusions The limited evidence showed that EIP can be provided in LMIC with adaptations for cultural factors and limited resources. Adaptations included collaboration with traditional healers, involving nonspecialist healthcare professionals, using mobile technology, considering the optimum use of long-acting antipsychotics, and monitoring antipsychotic side effects