Median survival time of patients after transcatheter chemo-embolization for hepatocellular carcinoma

Objective: To determine the effect on survival after transarterial chemoembolization (TACE) in patients with unresectable hepatocellular carcinoma (HCC).Design: Longitudinal cohort study.PLACE AND DURATION OF STUDY: Radiology Department, The Aga Khan University Hospital, Stadium Road, Karachi, from December 1997 to September 2005.PATIENTS AND Methods: Patients undergoing TACE procedure for HCC were prospectively followed. Fortythree patients were enrolled from December 1997 to March 2003 in the study and subjected to chemoembolization therapy. Eight out of 43 patients were excluded from the study, who lost to follow-up. All the patients were followed till their death. Median and mean survival were calculated.Results: The median survival of these 35 patients was 410 days (13.6 months), with 95% confidence interval (236 days lower bound and 536 days upper bound). Mean survival time was 603 days (20.1 months) with 95% confidence interval (394 days lower bound and 812 days upper bound). There was significant difference in mean survival time (in days) by Child s Pugh class (chi(2) = 12.384; df=2, p-value=0.002).CONCLUSION: The study showed that TACE is an effective palliative treatment. TACE increases the median survival time

Course Contents of English Language Textbooks and their Relevance to Learners’ Culture in an Islamic Context

The study is an attempt at analyzing the cultural authenticity of the course contents of English as a foreign language at International Islamic University Islamabad. This study assumes that these course contents increase cultural barriers for the learners who belong to a different set of cultural values and religious and educational background. It traces the limitation of foreign textbooks writers because of their unawareness of the local culture and the social, educational and religious environment. The study on the one hand questions the suitability of such textbooks for the learners (mostly from religious institutions) and on the other hand gives proposals for the development of English textbooks based on indigenous or Islamic culture. Usually, the evaluation of course contents is descriptive in nature and is done to describe or find out a problem rather than to address it. To bring an improvement in course contents is the basic goal of course evaluation. Although, it would be irrelevant to manipulate a problem statement for this type of research yet ignoring the student factor in writing English text books and selecting these books without doing a prior research into the needs analysis of the learners can be cited as the main problem which inspired the study. This study adopts both a descriptive as well as a prescriptive approach. It analyses the contents to see what is there in the contents and what is required for the learners from a cultural perspective. On the basis of its two fold description the study has given suggestions as to what should be an ideal situation for the selection, adaptation and development of English language textbooks for the learners. The main hypothesis of the study was that there was no cultural relevance between the objectives of the learners for learning English, their social and educational background and the contents of the course book. The inappropriateness of the theories that advocate the inclusion of target language culture in language courses as an essential factor for teaching and learning English in every situation and for all learners is the secondary hypothesis of the study. The study has narrowed down its focus to the cultural relevance of the course contents being taught at the IIUI, the communication gap between the authors and the target learners, and to give suggestions regarding the possibility to include the learners’ culture in English language courses.   The study adopts a first glance evaluation in the light of guidelines provided by pedagogical theorists and deliberately avoids learners’ response method (in which learners responses are measured) because of the   researcher’s own interest in the impressionistic evaluation. The main purpose of the study was to bring the learners in the lime light of focus to make teaching of English more learners’ centered, to create awareness among the teachers, policy makers and course designers to consider learners needs in the process of textbooks selection and development. The study proves that the themes, setting, characters and worldview, presented in the contents of the book represent a foreign and unfamiliar world for the learners. The study suggests that the learners would be more motivated to learn English if language were presented in the context with which the learners could identify themselves. Keywords: language, English, Culture, Textbooks, Learner

Does the inflow of remittances cause environmental degradation? Empirical evidence from China

Remittances inflow plays a significant role in promoting the economic welfare of a country; it has a multidimensional effect on the economy and links with the carbon emissions. This study examines the possible asymmetric transmissions from remittances to carbon dioxide emissions (CO2) in China using time series data from 1980 to 2014. The Non-linear NARDL method is employed to check the longrun asymmetric relationship between remittances inflow and carbon emissions. The findings show that a positive shock in remittances causes an increase in CO2 emissions, while a negative shock in remittances causes a decrease in CO2 emissions. The results support the existence of an asymmetric cointegrating relationship between remittances and CO2 emissions in both short run and the long run. The NARDL dynamic multiplier graph assumes that positive remittances shocks are highe compared to the negative remittances shocks. It suggests that policymakers in China should consider remittances as a policy instrument especially designing strategies and policies related to sustainable environmental quality in the long run

Reporting of mycetoma cases from skin and soft tissue biopsies over a period of ten years: A single center report and literature review from Pakistan

Background: Mycetoma is an important neglected tropical disease associated with debilitation, disfigurement and death if not diagnosed and treated adequately. In Pakistan, mycetoma cases have frequently been diagnosed in histopathology and microbiology laboratories. However, there is scarcity of published data from this country. Therefore, the objectives of this study were to evaluate the frequency and type of mycetoma reported in skin and soft tissue biopsies from a single center over 10 years and review of published literature from Pakistan.Method: This descriptive observational retrospective study was conducted at the Aga Khan University Hospital laboratory, Karachi, Pakistan. Laboratory data from 2009-2018 of skin and soft tissue biopsies with positive findings of mycetoma were retrieved from hospital information system. The variables for statistical analysis were age and gender of patient, anatomical site of lesion, residence of patient (geographical location) in the country, etiologic agents of mycetoma and significant gross and microscopic histopathological findings. The data was entered, and descriptive epidemiologic assessment was carried out using MS excel 2013. Geographical information system was used for mapping the location. Literature review of mycetoma cases reported from Pakistan was done on PubMed, Google search and PakMediNet from 1980 till April 2019.Result: During ten years of study period, 89 skin and soft tissue biopsies were reported as mycetoma, majority were eumycetoma [n = 66/89 (74%)] followed by actinomycetoma [n = 23/89 (26%)]. Involvement of lower limb was predominantly observed [n = 74/89 (83%)] in which foot had significant contribution [n = 65/74 (88%)]. Only 18 specimens were submitted for microbiological assessment and six grew agents of mycetoma, with Madurella mycetomatis reported in only three. Well-formed granuloma formation was observed in only 26%[n = 23/89] of cases. Specific geographical location was not identified, and cases were reported from across the country. From Pakistan, only two original papers and 7 case reports were available in published literature.Conclusion: This single center study reports a handful of cases of mycetoma from Pakistan. We conclude that the index of suspicion should remain high among treating surgeons and physicians and clinical laboratories should improve their diagnostic capacity and skills. This will have a great impact on disease outcome and patient\u27s life

The association of chest radiographic findings and severity scoring with clinical outcomes in patients with COVID-19 presenting to the emergency department of a tertiary care hospital in Pakistan

Introduction: While chest x-rays (CXRs) represent a cost-effective imaging modality for developing countries like Pakistan, their utility for the prognostication of COVID-19 has been minimally explored. Thus, we describe the frequency and distribution of CXR findings, and their association with clinical outcomes of patients with COVID-19.Methods: All adult (≥ 18 years) patients presenting between 28th February-31st May to the emergency department of a tertiary care hospital in Pakistan, who were COVID-19 positive on RT-PCR with CXR done on presentation, were included. A CXR Severity Score (CXR-SS) of 0-8 was used to quantify the extent of pulmonary infection on CXR, with a score of 0 being negative and 1-8 being positive. The patients\u27 initial CXR-SS and their highest CXR-SS over the hospital course were used for analysis, with cut-offs of 0-4 and 5-8 being used to assess association with clinical outcomes.Results: A total of 150 patients, with 76.7% males and mean age 56.1 years, were included in this study. Initial CXR was positive in 80% of patients, and 30.7% of patients had an initial CXR-SS between 5-8. The mortality rate was 16.7% and 30.6% patients underwent ICU admission with intubation (ICU-Int). On multivariable analysis, initial CXR-SS (1.355 [1.136-1.616]) and highest CXR-SS (1.390 [1.143-1.690]) were predictors of ICU-Int, and ICU-Int was independently associated with both initial CXR-SS 5-8 (2.532 [1.109-5.782]) and highest CXR-SS 5-8 (3.386 [1.405-8.159]). Lastly, age (1.060 [1.009-1.113]), initial CXR-SS (1.278 [1.010-1.617]) and ICU-Int (5.047 [1.731-14.710]), were found to be independent predictors of mortality in our patients.Conclusion: In a resource-constrained country like Pakistan, CXRs may have valuable prognostic utility in predicting ICU admission and mortality. Additional research with larger patient samples is needed to further explore the association of CXR findings with clinical outcomes

Determination of Crop Coefficient of Hybrid Wheat under Arid Climate: A Pot Study

Climate change increases vulnerabilities for crop productivity in Pakistan. Water crises are increasing with an increase in temperature and change in precipitation patterns due to climate change which ultimately imposed a threat to the food security of the country. Water is indispensable for all plants to complete life cycle as the unavailability of water at critical growth stages drastically affects the development of the plant. The present pot study was conducted for the estimation of crop coefficient of hybrid wheat for irrigation scheduling at Muhammad Nawaz Shareef University of Agriculture, Multan during two growing seasons 2018-19 and 2019-20. In this experiment, three wheat varieties were used were Hybrid-1 (R26-3-1/DH-16), Hybrid-2(AR 7-5 / ZWB-14), and Galaxy-2013 as treatment. The soil moisture content was maintained between 50 to 100 % available water content (AWC) during both growing seasons. The crop coefficient (Kc) and actual evapotranspiration (Eta) were maximum in galaxy-13 and minimum in hybrid wheat. The grain yield for Hybrid-1, Hybrid-2, and galaxy-13 was 1, 1.5, and 0.6 g plant-1, respectively while the straw output was 4.8, 4.3, and 3 g plant-1, respectively. The harvest index for Hybrid-1, Hybrid-2, and galaxy-13 were 20, 34, and 20% respectively. The water use efficiency (WUE) for Hybrid-1, Hybrid-2, and galaxy-13 was 0.2. 0.3 and 0.1 g plant-1mm-1, respectively. The Hybrid-1 and Hybrid-2 produced more grain yield, straw yield, more spikes, and more grains per spikes and showed more water use efficiency with short plant height as compared to galaxy-13. The results of the study revealed that Hybrid-2 is more water-efficient with low water requirement and it was followed by Hybrid-1. The growing of Hybrid-2 will enhance the wheat yield to meet the food requirements of the increasing population under the climate change scenario with less water

Model farm services centers in Khyber Pakhtunkhwa: Evaluation and the way forward

The sub-national Government of Khyber Pakhtunkhwa in Pakistan enacted Farm Services Centers Act, 2014, to establish Model Farm Services Centers (MFSCs) and Farm Services Centers as “one stop-shop” based on public-private partnership principle to strengthen extension system. The aim of these Centers is to empower small farmers at a platform to enhance their knowledge and skills and availability of quality agricultural inputs as stipulated in Section 4(g) of the Act, 2014, that each FSC shall “purchase certified seed, fertilizers, animal husbandry services, quality veterinary heath care services and medicines, farm machinery, expertise and technology for provision to the members who are registered with the Centre on affordable rates in comparison to open market rates”. The objective is to improve rural livelihoods, and development of the rural economy